East Meets West 2012 NRHA, TRHA, & AQHA – Alliance Event
ENTRY # _________
October 5 - 7, 2012 Great Southwest Equestrian Center, Katy, Texas
Check # _______ Open
Closed
Account Name: ________________________________________PAID Check $________ PAID Cash $________ (Person Responsible for Paying) Trainer:
________________________________
NRHA Horse’s Name _____________________________________ Comp Lic # ______________ Horse’s Barn Name _____________________ AQHA # ________________ Negative Coggins Accension # ______________
S G M Yr Foaled:_____ JR SR neg ____/____/____
Owner’s Name ______________________________________ SSN# _____________________
NRHA # ________________ AQHA # ________________
G NP Y L O AM N Y L
Owner’s Name ______________________________________ SSN# _____________________
NRHA # ________________ AQHA # ________________
G NP Y L O AM N Y L
Rider’s Name ______________________________________ SSN# _____________________
NRHA # ________________ AQHA # ________________
G NP Y L O AM N Y L
NO ADDRESS….NO SSN#.....NO PAYCHECK PAYEE: Rider or Owner Address_____________________________________________________ City ___________________________ State______ Zip ___________Phone (______)__________________
E-mail _______________________________________________________________ Class Order
Division Class #
Entry Judges Fee Fee
Friday, Oct 5th , Starting at 8:00 am 1st 9003 Ladies (JP) 20 20 9004 Mens (JP) 20 (class may be limited to 20 entries) 1100 1200 1301 1340 1350
3rd
5850
4th
10001 10002
2nd
Open ($1000) Int Open ($500) Ltd Open ($250) AQHA Open Rookie Pro (JP)
1700 1750
Office Use Only
Pattern #
________________________ NRHA #__________
2
G NP Y L
6
G NP Y
100 50 25 35 25
35 25 20 0 20
________________________ NRHA #__________
Int Hor NP ($250)
25
20
________________________ NRHA #__________
9
NP YNP
Green Level II Green Level I
20 20
0
________________________ NRHA #__________
4
GYA
________________________ NRHA #__________
8
G NP Y L
________________________ NRHA #__________
5
G NP Y
Saturday, Oct 6th , Starting at 8:00 am 1st 9003 Ladies (JP) 20 20 9004 Mens (JP) 20 (class may be limited to 20 entries) 2nd
Rider (if different from above)
Nov Hor Op L1($200) 20 Nov Hor Op L2($250) 25
20
O AM N Y
________________________ AQHA #__________
Horse Name____________________________________ 3rd
1800 1850
Nov Hor NP L1 ($200) 20 Nov Hor NP L2 ($250) 25
4th
3500
Yth 10 & < Short Stir
5th
3100 3200 4347 4348
9801
6th
ENTRY # _________
________________________ NRHA #__________
6
10
0
________________________ NRHA #__________
12 Y YNP
10 10 10 10
0
________________________ NRHA #__________
2
TRHA $1000 Rider (JP) 20
20
Yth 13 & < Yth 14–18 AQHA 13 & U AQHA 14 – 18
________________________ TRHA Member
8
NP TRHA
________________________ NRHA #__________
6
G NP Y L
NP only
1400 1500 1600 1650 2340 2348
Non Pro ($1000) 100 35 ________________________ NRHA #__________ Int NP ($500) 50 25 Ltd NP ($200) 20 20 PT N Pro ($200) 20 AQHA Am Rein* 35 0 ________________________ AQHA #__________ AQHA Am Select* 35 0 (*AQHA Riders may enter only Amateur or Amateur Select – NOT Both)
8
3rd
3340 5300 5301 5310
AQHA Nov Am 35 0 ________________________ AQHA #__________ Rookie I (JP) 20 20 ________________________ NRHA #__________ Prime Time Rookie (JP) 20 Rookie II (JP) 20 (*PT Rookie must also enter Rookie Level 2)
5
4th
5750
Int Hor OP ($250)
25
20
Y YNP Y
________________________ AQHA #__________
Sunday, Oct 7th , Starting at 8:00 am 1st 9003 Ladies (JP) 20 20 9004 Mens (JP) 20 (class may be limited to 20 entries) 2nd
NP Only
20
________________________ NRHA #__________
AM or AM SEL Nov AM NP Y
10 G Y
(Only one Judges Fee for Concurrent Classes – Highest fee applies) Charges
Checks payable to: GSEC
FOR OFFICE USE ONLY
Entry fee total - - - - - - - - - - - - - - - - =________ Judges fee total - - - - - - - - - - - - - - - - =________ Office fee $25 - - - - - - - - - - - - - - - - - - =___25___ (Youth Only Classes-office fee free) Stall _____ X $110 For Show (10/2-10/6) - - - - - =________ Early Arrival (Mon 10/1) $30/stall - - - - - - - - =________ Three night stall _____ X $90 - - - - - - - - - - =________ Two night stall _____ X $60 - - - - - - - - - - - =________ One night stall _____ X $40 - - - - - - - - - - - =________ Stall/Ground Fee____ X $40 Per _____ DAY - - =________ Shavings _____ bag(s) X $11 per bag - - - - - =________
________ ________ ___25___
________ ________ ___25___
________ ________ ________ ________ ________ ________ ________
________ ________ ________ ________ ________ ________ ________
________ ________ ________
________ ________ ________
_________
_________
(must be purchased from GSEC) Paid Warm Ups _____X $25 for 8 min - - - - - - =________ RV Space ______ X $30 per ____ Nights - - - - =________ AQHA Drug Testing $5.00/horse/show - - - - - =________
FINAL TOTAL =
_________
WARNING: Under Texas Law (Chapter 87, Civil Practice and Remedies Code), an equine professional is not liable for an injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities. I further understand that all horses must be stalled due to facility requirement. Horses are not allowed to be tied to trailers for extended periods or overnight. I will abide by this requirement Signature: ___________________________________________
Date: October_____, 2012