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American Shorthorn Association DNA Testing Submission Form Contact the ASA for blood sample cards. Cards must accompany this form and returned with payment. REQUIRED FOR ALL ANIMALS Revised 4.13.16 By checking A.I. Sire/Donor Dam Requirement, testing will include GGP LD, Parentage, TH, PHA, & DS. Additional genetic conditions can be added with GGP products for $16 American Shorthorn Association Authorization "I hereby agree that all genetic material submitted is the sole property of the A.S.A. I hereby authorize A.S.A. to publish all genetic testing data results obtained now and in the future to the general public from any sample submitted. I agree to waive and hold harmless and indemnify ASA and GeneSeek from any claim arising from testing or publications of data." Signature/Date Print Name Billing Information (Payment must be received prior to testing) Customer Information Farm Name: Payment Method: Credit Card Contact Person: Name on Card: ASA Member #: Billing Address: Phone: (Check if Same as Address to Left) E-mail: Card Number: Address: Visa MasterCard Discover Expiration Date (MM/YYYY): / CVV2 (Last 3 digits of number printed on the back of card): Signature: Ex: 1 2 3 4 5 6 7 8 9 10 F SH SH PLEASE SUBMIT COMPLETED FORM TO: AMERICAN SHORTHORN ASSOCIATION - 7607 NW Prairie View Rd., Kansas City, MO 64151 Add. Genetic Condition - $27 DS - $27 PHA - $27 TH - $27 Genetic Condition Pricing if GGP-HD or LD ordered $16 per test (Add all initials below) - TH, PHA, DS Stand - Alone Tests Parentage - $35 GGP - LD Profile - $55 Dam Reg # 416229 GGP - HD 150K Profile - $90 Sire Reg # 418549 GGP - HD Profile + TH, PHA, DS - $125 DOB 3/21/2014 A.I. Sire/Donor Dam Requirement - $85 Reg # 418549 Breed: SH, MA, etc. Tattoo 1234B Breed: SH, MA, etc. Sample Barcode 11112154 Sex (M or F) Genomic Tests TH, PHA, DS - $69 City: State: Zip Code: Check DNA Testing Options GGP – Low Density (LD) w/ TH, PHA, DS – $85 – this is a low density panel that includes parentage markers and genetic condition testing for TH, PHA and DS. This slate of tests can be used for all AI Sires and Donor Dams. GGP – High Density (HD) w/ TH, PHA, DS - $125 – this is a high density (150K) panel that includes parentage markers and genetic condition testing for TH, PHA and DS. This test is recommended for elite sires and dams. Breeders may choose this option to satisfy all AI Sire/Donor Dam Requirements. GGP-HD - $90 – this is a high-density (150K) panel that includes parentage markers. This test is recommended elite sires and dams. GGP–LD - $55 – this is a low density panel that includes parentage markers. This test is recommened for young bulls, heifers or testing the entire cow herd. Please note that all of the above GGP options include parentage markers and the animals profiled will receive GE -EPDs Stand-Alone DNA Tests Stand-Alone tests can be ordered independently of GGP products. Animals tested under these tests will not receive GE-EPDs. If a breeder does not wish to receive GE-EPDs on their AI Sire/Donor Dam they may order stand-alone tests for parentage, TH, PHA and DS to meet the requirements. Parentage Markers - $35 – parentage verification can be completed if parents are on file with the ASA Tibial Hemimelia (TH) - $27 Pulmonary Hyposlasia w/ Anasarca (PHA) - $27 Digital Subluxation (DS) - $27 TH, PHA, DS Bundle - $69