GENUS NAME:	__________________	CULTIVAR NAME:	___________________________________________
			(Limit - 10 syllables - 30 letters)

SPECIES CULTIVAR:

Genus: _________________________________________________ Species: ___________________________________________________________

Variety: ________________________________________________ Date of Discovery: ___________________________________________________

HYBRID CULTIVAR: (Please fill in as much information as possible)

CROSS DATE: ___________________________________ FIRST BLOOM DATE: ___________________________________

SEED PARENT:

If hybrid, give cultivar name, or formula, and/or hybridizer #

Name: ____________________________________________________________________________________________________________________

or Formula: _______________________________________________________ x _______________________________________________________

If not hybrid

Genus: ________________________________________________ Species: ____________________________________________________________

Variety: _______________________________________________ or Cultivar: __________________________________________________________

POLLEN PARENT:

If hybrid, give cultivar name, or formula, and/or hybridizer #

Name: ____________________________________________________________________________________________________________________

or Formula: _______________________________________________________ x _______________________________________________________

If not hybrid

Genus: ________________________________________________ Species: ____________________________________________________________

Variety: _______________________________________________ or Cultivar: __________________________________________________________

SPORT: (Name of plant that gave rise to sport) ___________________________________________________________________________________

COLLECTOR/HYBRIDIZER:

Name: ____________________________________________ Address: ________________________________________________________________

City: _______________________________________ State: _________________________ Country: _______________________ Zip: ____________

Telephone: __________________________ Fax: __________________________ Email: _________________________________________________

APPLICANT:

Name: ____________________________________________ Address: ________________________________________________________________

City: _______________________________________ State: _________________________ Country: _______________________ Zip: ____________

Telephone: __________________________ Fax: __________________________ Email: _________________________________________________

GENERAL DESCRIPTION OF CULTIVAR:

__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

CULTIVAR GROUP: (Species or cultivar group that new cultivar most resembles) _______________________________________________________

DESCRIBE CHARACTERS MAKING CULTIVAR UNIQUE/DIFFERENT:

__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

Photographs will be placed on a Web site for open access and referenced in the BCR. Credit will be given.

APPLICANT SIGNATURE: _________________________________________________________________ Date: ___________________________