** official entry form mailed & couriered: rl...
TRANSCRIPT
ARABIAN BREEDERS **
�rl�?ffi Official Entry Form
Arabian Breeders World Cup
April 8-11, 2020
Mail Entry Forms & Fees to: Mailed & Couriered:
Mary Kanaga - Shaw Secretary
15455 N Greenway-Hayden Loap C18
Scottsdale, AZ 85260
Email: [email protected]
PLEASE TYPE OR CLEARLY PRINT. ONLY ONE HORSE PER ENTRY FORM. All entries must be complete and contain the correct fees. Enclose copies of horse registration papers (both sides), purchase contract (if applicable), USEF/CEF membership cards, amateur certification (if applicable) for each rider, handler and owner.
Registration # I Name of Horse I Date of Birth I
Sex I Color
Sire I Dam I Breeder
Rider/Driver/Handler Class# Class# aass# Class# aass# Entry Fees $
USEF#
Rider/Driver/Handler Class# Class# aass# Class# aass# Entry Fees
USEF#
Rider/Driver/Handler Class# Class# aass# Class# aass# Entry Fees $
USEF#
FOR MORE THAN FOUR RIDERS WITH SAME HORSE, USE ADDITONAL ENTRY FORM, LEAVING HORSE DATA BLANK. OWNERS ENTERING MORE THAN ONE HORSE, USE ADDITIONAL ENTRY FORM(S) Each person signing this entry form acknowledges that he/she has read the front and reverse side of this official entry form and agrees to the applicable terms, conditions, waivers, releases, Indemnification and consent as set forth herein. Each person agrees that information Is accurate to the best of his/her knowledge.
R (As it appears on horse registration papers or contract)
Name
Farm/
Addre
City/St
Phone
Ranch
ss
ate/Zip
:
TRAIN ER
Name
Farm N
Addre
City/St
Phone
ame
ss
ate/Zip
:
USEF/CEF#
USEF Farm#
USEF/CEF #
AMAT EUR CERTIFICATION {For amateurs in all amateur and amateur owner classes)
Relationship to horse owner
Name
Age_
STABL ING INFORMATION
l woul d like to be stabled with
USEF Amateur#
Total Entry Fees (total fees from above) .......... ... $
Stabling Fees
_ Horse Stall @$250 each .............................. $
-
Tack Room @ $250 each ............................. $
_ Grounds Fee@ $50 each (If no stall is purchased)$
Mandatory Fees
_ Office Fee@ $SO/horse ............................... $ 50.00
_ USEF Federation Fee@ $23/horse .............. $ 23.00
(Includes $15 D&M and $8 Federation Fee)
Non-Member Fees (USEF): _ USEF Non-member Fee @$45/person ......... $
_ Equine Promotion Fee @ $2500/horse ........ $ (Horses on site that are not entered into the horse show)
Late Entry Fees
_ Late Entry Fee @ $250 per horse ................. $
_ Late Fee Missing Registration Papers@
$10/horse .. $
Enclosed Total Fees $
Credit Card Type: □ Visa □ MC □ AMX
Credit Card #:
Expiration Date:
CCV Code:
Name on Card:
Signature: $50 fee will be charged for all credit cards that are declined or invalid/per attempt
Owners, Trainers, Coach, Riders, Drivers & Handlers (or parent if rider, driver or handler is a minor) must sign a USEF release on reverse of this form.
CLOSING DATE OF ENTRIES: Entries MUST BE postmarked by March 6, 2020 ~ Late Entries $250 penalty per horse
Page 17
