Name(s)

Street Address

City State Zip

Are you a member of an AHA Registered Homebrew Club?      Yes      No

If so, what is its name?   (Please spell out the full club name. Do not abbreviate)

Name of Brew  Category/Subcategory (print full names) Category   Subcategory

Special Ingredients/Classic Style:

Recipe is:     Malt Extract Only       Malt Extract & Grain       All-grain       Mead       Cider       Saké For Mead, Cider, Saké:     Dry       Medium       Sweet

Number of U.S. gallons brewed for this recipe   WATER TREATMENT  Type(s) Amount(s) YEAST CULTURE        Liquid   Dried Did you use a starter?   Yes     No Brand and Type YEAST NUTRIENTS  Type Brand Amount CARBONATION  Type Amount Use of Kegs? BOIliNG TIME   SPECIFIC GRAVITIES   Original   Terminal

HOPS TYPE PELLETS OR WHolE? AMOUNT (oz.) % A ACID USE (BOIL, DRY, ETC.) TIME                                                                                     MALT (GRAIN, EXTRACTS AND/OR OTHER FERMENTABLES): TYPE/brAND AMOUNT (lb.s) USE (STEP/MASH) TIME TEMP.

FERMENTATION   Primary Secondary Other

Duration (days)

Temperature

Type of Fermenter (glass, plastic, etc.)

DATE THIS brEW WAS BOTTLED