Welcome to the ON-LINE Entry form for the Pine Rock Farm/NWHA 2011 Show Series. There should be only ONE FORM PER HORSE.  Check the button beside the date for the show you are attending during THIS registration:

Show Dates--PICK 1 for this Registration
March 26, 2011
May 28, 2011
September 10, 2011
I will be attending all of the Pine Rock Show Series

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An OPEN Check AND a Current Coggins MUST be left at the show office before an entry packet will be released.

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HORSE INFORMATION

Name of Horse (no nicknames please):

Gender(Pick One): Stallion Mare Gelding

Age:

Foal Date (mm/dd/yyyy):

Breed of Horse (Pick One): Walking Horse Racking Horse Spotted Saddle Horse Other

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OWNER INFORMATION

Owner's Name (FirstName Last Name):

Owner's Address:

Owner's City:

Owner's State, Zip:

Telephone Number (Home):

Telephone Number (Mobile):

E-Mail Address: (Your conformation will come to this email)

NWHA Membership Number:

NWHA Membership Designation (Pick One): Adult Youth

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TRAINER INFORMATION

Trainer's Name:

Trainer's Address: 

Trainer's City:

Trainer's State, Zip: 

Trainer's Stable/Farm Name:

Trainer's Telephone Number:

Trainer's E-Mail Address:

Trainer's NWHA Membership Number: ___________________________________________________________________________

EXHIBITOR 1 INFORMATION

Exhibitor 1 Name:

Exhibitor 1 Address:

Exhibitor 1 City:

Exhibitor 1 State, Zip:

Exhibitor 1 Telephone (Home):

Exhibitor 1 Date of Birth (Youth Only): (mm/dd/yyyy)

Exhibitor 1 NWHA Membership Number:

Exhibitor 1 NWHA Show Status (Pick One): OPEN AMATEUR YOUTH

Exhibitor 1 Classes Entered (Example 2,10,33): _______________________________________________________________________________

EXHIBITOR 2 INFORMATION

Exhibitor 2 Name:

Exhibitor 2 Address:

Exhibitor 2 City:

Exhibitor 2 State, Zip:

Exhibitor 2 Telephone (Home):

Exhibitor 2 Date of Birth (Youth Only): (mm/dd/yyyy)

Exhibitor 2 NWHA Membership Number:

Exhibitor 2 NWHA Show Status (Pick One): OPEN AMATEUR YOUTH

Exhibitor 2 Classes Entered (Example 2,10,33): _______________________________________________________________________________

EXHIBITOR 3 INFORMATION

Exhibitor 3 Name:

Exhibitor 3 Address:

Exhibitor 3 City:

Exhibitor 3 State, Zip:

Exhibitor 3 Telephone (Home):

Exhibitor 3 Date of Birth (Youth Only): (mm/dd/yyyy)

Exhibitor 3 NWHA Membership Number:

Exhibitor 3 NWHA Show Status (Pick One): OPEN AMATEUR YOUTH

Exhibitor 3 Classes Entered (Example 2,10,33): _______________________________________________________________________________

EXHIBITOR 4 INFORMATION

Exhibitor 4 Name:

Exhibitor 4 Address:

Exhibitor 4 City:

Exhibitor 4 State, Zip:

Exhibitor 4 Telephone (Home):

Exhibitor 4 Date of Birth (Youth Only): (mm/dd/yyyy)

Exhibitor 4 Address:

Exhibitor 4 NWHA Show Status (Pick One): OPEN AMATEUR YOUTH

Exhibitor 4 Classes Entered (Example 2,10,33): _______________________________________________________________________________

FEE INFORMATION

DQP Fee (per horse): $0.00 $10.00

All Show Fee (ONE horse/rider combination) Pre-Entry: $0.00 $50.00

All Show Fee (ONE per horse/rider combination) Post-Entry: $0.00 $55.00

Individual Class Fees (for individual or multiple riders) Pre-Entry: 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 $15.00 per class

Individual Class Fees (for individual or multiple riders) Post-Entry: 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 $20.00 per class

NWHA Show Card (if you are NOT an NWHA member) Required: $0.00 $15.00 $40.00 (Show Card Info:  $15.00 per show or $40.00 for 2010 NWHA show season)

Show Card Status (Pick One): OPEN AMATEUR YOUTH   NWHA memberships will be available at the show. ______________________________________________________________________________

Every Entry shall constitute an agreement that the person making it, owners, exhibitors, lessee, trainer, manager, agent, coach, rider and the horse shall be subject to the bylaws and the Rules of the NWHA and the local rules of the show.  Further, it shall constitute a declaration that the horse and/or rider is eligible as entered and that the owner and all of his/her representatives are bound by the bylaws and Rules of the NWHA and the show and accept as final the decision of the NWHA on any question arising under the Rules, and agree to hold the show, the NWHA, their officials, directors and employees harmless for any action taken.

Signature of Owner/Agent:________________________________________________________  

Signature of Parent/Guardian, if youth rider:___________________________________________  

SIGNATURES WILL BE REQUIRED BEFORE AN ENTRY PACKET WILL BE RELEASED.