Check one: Cultivar___ Germplasm___ Parental Line___ Genetic Stock___

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NAME OF MATERIAL & CROP: (List exactly as you wish Certificate printed).

_______________________________

Examples: POST BARLEY (for cultivar)

SEVEN COTTON (for germplasm)

C37 SUGARBEET (for parental line)

SIX HIGH NECTAR ALFALFA (for genetic stocks)

(Only one certificate will be issued to each author to cover all germplasms or parental

lines described in any one registration manuscript).

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NAMES OF AGENCY & ORGANIZATION: List in priority order exactly as you wish certificate

printed, one certificate will be sent to each author, see examples below for preparing names of

agency and organization.

______________________________________

______________________________________

______________________________________

______________________________________

Examples:

_____Agric. Exp. Stn.

(STATE)

Some exceptions to State Agric. Exp. Stn. and other Institutional examples are:

Iowa Agric. and Home Econ, Exp. Stn.

Mississippi Agric. and Forestry Exp. Stn.

North Carolina Agric. Res. Serv.

Ohio Agric. Res. and Dev. Center

USDA-Agricultural Research Service

Agric. and Agric. - Food Canada;__________Res. Centre

___________________________________

Signature of Corresponding Author

REG NO. ___________________

REG. DATE_________________

(This form may be duplicated as needed)