Registration Application for CLIVIA

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General Info
Your Name: 
E-mail: 
Enter E-mail Again: 
Proposed Cultivar Name: 
Date: 
Originator Info 
Name: 
Address: 
City: 
State: 
Postal Code: 
Country: 
Nominant Info    Same as Originator 
Name: 
Address: 
City: 
State: 
Postal Code: 
Country: 
Introducer Info   Same as Originator 
Name: 
Address: 
City: 
State: 
Postal Code: 
Country: 
Registrant Info   Same as Originator 
Name: 
Address: 
City: 
State: 
Postal Code: 
Country: 
Publication Info
If the plant name has already been published, please supply full details of the publication. (Please attach a copy of the publication pages with your application).

Publication Title: 
Title of Article 
(if applicable):
 
Volume/issue 
number of Publication:
 
Page Number: 
Date of Publication: 
Country of Publication: 
Alphabet
Is the name a transliteration of a non-Latin alphabet language? 
Yes   No
If yes, please supply the 
name in its original script:
 
Parentage
1. If the plant is a hybrid, please supply breeding details:
Berry Parent: 
Pollen Parent: 
2. If the plant is a sport, state the parent plant
on which the sport occurred:
Sport Parent: 
More Info
If the cultivar results from a plant or plants growing in the wild, please state the locality and country of origin:

Please supply details of any trademarks, plant patents or Plant Breeders Rights associated with this plant:

Has this plant received any Awards? 
Yes  No
Award Date: 
Award: 
Awarding Body: 

Please give a full description of the plant.

State the diagnostic characteristics that differentiate this cultivar or cultivar-group from other cultivars or cultivar-groups.

State the preferred method/methods that this plant may be propagated. Division of offsets   Seeds and Offsets (for cultivar groups only) .

Please explain the meaning or derivation of your cultivar name.

Please add any other information not already covered that may be helpful:

Please indicate if you would like to receive a “Certificate of International Registration”    Yes   No


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