http://www.gswec.com/downloads/2010NorthSouthChallengeEntryForms

Page 1

Entry # Horse Information

Color

Height

USEF #/USHJA# THJA# # 1-Rider Information Name: Address: City, State, Zip: Phone # Social Security # DOB/Age: ASPCA# USEF#/USHJA# THJA#

Southbound Show Management, Inc. 785 W. Jeter Road Argyle, Texas 76226 (940) 240-1207

Somervelle County Expo Center Entry Deadline is January 6, 2010

Name:

Green

Mail Entries To:

Blue Ribbon Winter Festival, January 20-24, 2010

Age

Owner Information Name: Address: City, State, Zip: Phone# Social Security # USEF#/USHJA# THJA# #2 Rider Information Name: Address: City, State, Zip: Phone # Social Security # DOB/Age: ASPCA# USEF#/USHJA# THJA# Federation Entry Agreement

Trainer Information Name: Address: City, State, Zip: Phone # USEF#/USHJA# THJA# Social Security # Barn Name: Alternate Payee for Prize Money Name: Address: City, State, Zip: Phone # SSN#

I have read the United States Equestrian Federation, Inc. (the “Federation”) Entry Agreement (GR906.4) as printed in the Prize List for Blue Ribbon Winter Festival, and agree to all of its provisions. I understand and agree that by entering this Competition, I am subject to Federation Rules, Prize List, and local rules of the competition. I agree to waive the right to the use of my photos from the competition, and agree that any actions against the Federation must be brought in New York State.

Division Entry Information *Please Circle Divisions & Indicate Rider # Wrk Htr___ 1st Y Grn__ 3’6” A/O __ Rg Conf____ 2nd Y Grn__ 3’3” A/O___ Grn Conf__ Sm Jr 15/U_ Sm Jr 16/17___ Lg Jr 15/U____ L Jr 16/17_ Ch Pony___ Sm Pony___ Md Pony__ Lg Pony___ A/A 18/35__ Gr Pny/L__ Gr Pny/SM___ A/A 36/49__ Ch 14/U___ 3’ Pre Gr___ A/A 50/O__ Ch 15/17__ 3’3” Pre Gr___ Baby Gr____ S/L Str Htr___ EQ___ Sp Htr___ Mod Htr___ Mod C/A___ Jumpers: M .95____ M 1.0 _____ M 1.15____ M 1.25___ M 1.35___ J/A Low__ J/A High___ C/A Low___ A High___ C High___ Equitation: Open/Low Classes: Individual Classes/Classics: Stable With:

Federation Release, Assumption of Risk, Waiver, and Indemnification This document waives important legal rights. Read it carefully before signing. I AGREE in consideration for my participation in this Competition, the Blue Ribbon Winter Festival, to the following: I AGREE that “the Federation” and “Competition” as used herein includes the Licensee and Competition Management, as well as all of their officials, officers, directors, employees, agents, personnel, volunteers and Federation affiliates. I AGREE that I choose to participate voluntarily in the Competition with my horse, as a rider, driver, handler, vaulter, longeur, lessee, owner, agent, coach, trainer, or as parent or guardian of a junior exhibitor. I am fully aware and acknowledge that horse sports and the Competition involve inherent dangerous risks of accident, loss, and serious bodily injury including broken bones, head injuries, trauma, pain, suffering, or death. (“Harm”). I AGREE to hold harmless and release the Federation and the Competition from all claims for money damages or otherwise for any Harm to me or my horse and for any Harm of any nature caused by me or my horse to others, even if the Harm arises or results, directly or indirectly, from the negligence of the Federation or the Competition. I AGREE to expressly assume all risks of Harm to me or my horse, including Harm resulting from the negligence of the Federation or the Competition. I AGREE to indemnify (that is, to pay any losses, damages, or costs incurred by) the Federation and the Competition and to hold them harmless with respect to claims for Harm to me or my horse, and for claims made by others for any Harm caused by me or my horse while at the Competition. I have read the Federation Rules about protective equipment, including GR801 and, if applicable, EV114, and I understand that I am entitled to wear protective equipment without penalty, and I acknowledge that the Federation strongly encourages me to do so while WARNING that no protective equipment can guard against all injuries. If I am a parent or guardian of a junior exhibitor, I consent to the child’s participation and AGREE to all of the above provisions and AGREE to assume all of the obligations of this Release on the child’s behalf. I represent that I have the requisite training, coaching and abilities to safely compete in this competition. I AGREE that if I am injured at this competition, the medical personnel treating my injuries may provide information on my injury and treatment to the Federation on the official USEF accident/injury report form. BY SIGNING BELOW, I AGREE to be bound by all applicable Federation Rules and all terms and provisions of this entry blank.

Fees #_________ Stalls @ $175 Nominating Fee $150 USEF Non Member Amateur Card $30 USEF JR Non-Member Fee $30 USEF SR Non-Member Fee $30 USHJA Non-Member Fee $30 USEF Drug Fee $7+ USEF Fee $8

$15

USHJA Zone Support Fee @ $2 Office Fee $50 Non-Showing Fee $100 Grounds Fee $50 Late Fee $35

$2

Reserve Campers on the Enclosed Form Order Shavings/Feed/Hay on the Enclosed Form

Emergency Phone Contact_________________________ Rider/Handler (Mandatory) Signature:

Owner/Agent (Mandatory) Signature:

Trainer (Mandatory) Signature:

Coach (If Applicable) or Rider #2 Signature:

Print Name:

Print Name:

Print Name:

Print Name:

Parent/Guardian Signature (required if Rider/Driver/Handler/Vaulter/Longeur Is a Minor) Emergency Phone Contact_____________________________ Print Parent/Guardian Name:_______________________Parent/Guardian Signature:_________________________Is rider a US citizen?_____________

Total Enclosed

*Office Use Only


Entry # Horse Information

Color

Height

USEF #/USHJA# THJA# # 1-Rider Information Name: Address: City, State, Zip: Phone # Social Security # DOB/Age: ASPCA# USEF#/USHJA# THJA#

Southbound Show Management, Inc. 785 W. Jeter Road Argyle, Texas 76226 (940) 240-1207

Somervelle County Expo Center Entry Deadline is January 6, 2010

Name:

Green

Mail Entries To:

Winter Warm Up, January 27-31, 2010

Age

Owner Information Name: Address: City, State, Zip: Phone# Social Security # USEF#/USHJA# THJA# #2 Rider Information Name: Address: City, State, Zip: Phone # Social Security # DOB/Age: ASPCA# USEF#/USHJA# THJA# Federation Entry Agreement

Trainer Information Name: Address: City, State, Zip: Phone # USEF#/USHJA# THJA# Social Security # Barn Name: Alternate Payee for Prize Money Name: Address: City, State, Zip: Phone # SSN#

I have read the United States Equestrian Federation, Inc. (the “Federation”) Entry Agreement (GR906.4) as printed in the Prize List for the Winter Warm Up, and agree to all of its provisions. I understand and agree that by entering this Competition, I am subject to Federation Rules, Prize List, and local rules of the competition. I agree to waive the right to the use of my photos from the competition, and agree that any actions against the Federation must be brought in New York State.

Division Entry Information *Please Circle Divisions & Indicate Rider # Wrk Htr___ 1st Y Grn__ 3’6” A/O __ Rg Conf____ 2nd Y Grn__ 3’3” A/O___ Grn Conf__ Sm Jr 15/U_ Sm Jr 16/17___ Lg Jr 15/U____ L Jr 16/17_ Ch Pony___ Sm Pony___ Md Pony__ Lg Pony___ A/A 18/35__ Gr Pny/L__ Gr Pny/SM___ A/A 36/49__ Ch 14/U___ 3’ Pre Gr___ A/A 50/O__ Ch 15/17__ 3’3” Pre Gr___ Baby Gr____ S/L Str Htr___ EQ___ Sp Htr___ Mod Htr___ Mod C/A___ Jumpers: M .95____ M 1.0 _____ M 1.15____ M 1.25___ M 1.35___ J/A Low__ J/A High___ C/A Low___ A High___ C High___ Equitation: Open/Low Classes: Individual Classes/Classics: Stable With:

Federation Release, Assumption of Risk, Waiver, and Indemnification This document waives important legal rights. Read it carefully before signing. I AGREE in consideration for my participation in this Competition, the Winter Warm Up, to the following: I AGREE that “the Federation” and “Competition” as used herein includes the Licensee and Competition Management, as well as all of their officials, officers, directors, employees, agents, personnel, volunteers and Federation affiliates. I AGREE that I choose to participate voluntarily in the Competition with my horse, as a rider, driver, handler, vaulter, longeur, lessee, owner, agent, coach, trainer, or as parent or guardian of a junior exhibitor. I am fully aware and acknowledge that horse sports and the Competition involve inherent dangerous risks of accident, loss, and serious bodily injury including broken bones, head injuries, trauma, pain, suffering, or death. (“Harm”). I AGREE to hold harmless and release the Federation and the Competition from all claims for money damages or otherwise for any Harm to me or my horse and for any Harm of any nature caused by me or my horse to others, even if the Harm arises or results, directly or indirectly, from the negligence of the Federation or the Competition. I AGREE to expressly assume all risks of Harm to me or my horse, including Harm resulting from the negligence of the Federation or the Competition. I AGREE to indemnify (that is, to pay any losses, damages, or costs incurred by) the Federation and the Competition and to hold them harmless with respect to claims for Harm to me or my horse, and for claims made by others for any Harm caused by me or my horse while at the Competition. I have read the Federation Rules about protective equipment, including GR801 and, if applicable, EV114, and I understand that I am entitled to wear protective equipment without penalty, and I acknowledge that the Federation strongly encourages me to do so while WARNING that no protective equipment can guard against all injuries. If I am a parent or guardian of a junior exhibitor, I consent to the child’s participation and AGREE to all of the above provisions and AGREE to assume all of the obligations of this Release on the child’s behalf. I represent that I have the requisite training, coaching and abilities to safely compete in this competition. I AGREE that if I am injured at this competition, the medical personnel treating my injuries may provide information on my injury and treatment to the Federation on the official USEF accident/injury report form. BY SIGNING BELOW, I AGREE to be bound by all applicable Federation Rules and all terms and provisions of this entry blank.

Fees #_________ Stalls @ $175 Nominating Fee $150 USEF Non Member Amateur Card $30 USEF JR Non-Member Fee $30 USEF SR Non-Member Fee $30 USHJA Non-Member Fee $30 USEF Drug Fee $7+ USEF Fee $8

$15

USHJA Zone Support Fee @ $2 Office Fee $50 Non-Showing Fee $100 Grounds Fee $50 Late Fee $35

$2

Reserve Campers on the Enclosed Form Order Shavings/Feed/Hay on the Enclosed Form

Emergency Phone Contact_________________________ Rider/Handler (Mandatory) Signature:

Owner/Agent (Mandatory) Signature:

Trainer (Mandatory) Signature:

Coach (If Applicable) or Rider #2 Signature:

Print Name:

Print Name:

Print Name:

Print Name:

Parent/Guardian Signature (required if Rider/Driver/Handler/Vaulter/Longeur Is a Minor) Emergency Phone Contact_____________________________ Print Parent/Guardian Name:_______________________Parent/Guardian Signature:_________________________Is rider a US citizen?_____________

Total Enclosed

*Office Use Only


Entry #

Great Southwest Winter Series I, February 3-7, 2010 Great Southwest Equestrian Center Entry Deadline is January 22, 2010

Horse Information Name:

Green

Color

Height

USEF #/USHJA# THJA# # 1-Rider Information Name: Address: City, State, Zip: Phone # Social Security # DOB/Age: ASPCA# USEF#/USHJA# THJA#

Age

Owner Information Name: Address: City, State, Zip: Phone# Social Security # USEF#/USHJA# THJA# #2 Rider Information Name: Address: City, State, Zip: Phone # Social Security # DOB/Age: ASPCA# USEF#/USHJA# THJA# Federation Entry Agreement

Trainer Information Name: Address: City, State, Zip: Phone # USEF#/USHJA# THJA# Social Security # Barn Name: Alternate Payee for Prize Money Name: Address: City, State, Zip: Phone # SSN#

I have read the United States Equestrian Federation, Inc. (the “Federation”) Entry Agreement (GR906.4) as printed in the Prize List for the Great Southwest Winter Series I, and agree to all of its provisions. I understand and agree that by entering this Competition, I am subject to Federation Rules, Prize List, and local rules of the competition. I agree to waive the right to the use of my photos from the competition, and agree that any actions against the Federation must be brought in New York State.

Mail Entries To: Pauline Cook/Great Southwest Equestrian Center 2501 South Mason Road, Suite 100 Katy, TX 77450 281-579-1272

Division Entry Information *Please Circle Divisions & Indicate Rider # Wrk Htr___ 1st Y Grn__ 3’6” A/O __ Rg Conf____ 2nd Y Grn__ 3’3” A/O___ Grn Conf__ Sm Jr 15/U_ Sm Jr 16/17___ Lg Jr 15/U____ L Jr 16/17_ Ch Pony___ Sm Pony___ Md Pony__ Lg Pony___ A/A 18/35__ Gr Pny/L__ Gr Pny/SM___ A/A 36/49__ Ch 14/U___ 3’ Pre Gr___ A/A 50/O__ Ch 15/17__ 3’3” Pre Gr___ Baby Gr____ S/L Str Htr___ EQ___ Sp Htr___ Mod Htr___ Mod C/A___ Jumpers: M .95____ M 1.0 _____ M 1.15____ M 1.25___ M 1.35___ J/A Low__ J/A High___ C/A Low___ A High___ C High___ Equitation: Open/Low Classes: Individual Classes/Classics: Stable With:

Federation Release, Assumption of Risk, Waiver, and Indemnification This document waives important legal rights. Read it carefully before signing. I AGREE in consideration for my participation in this Competition, the Great Southwest Winter Series I, to the following: I AGREE that “the Federation” and “Competition” as used herein includes the Licensee and Competition Management, as well as all of their officials, officers, directors, employees, agents, personnel, volunteers and Federation affiliates. I AGREE that I choose to participate voluntarily in the Competition with my horse, as a rider, driver, handler, vaulter, longeur, lessee, owner, agent, coach, trainer, or as parent or guardian of a junior exhibitor. I am fully aware and acknowledge that horse sports and the Competition involve inherent dangerous risks of accident, loss, and serious bodily injury including broken bones, head injuries, trauma, pain, suffering, or death. (“Harm”). I AGREE to hold harmless and release the Federation and the Competition from all claims for money damages or otherwise for any Harm to me or my horse and for any Harm of any nature caused by me or my horse to others, even if the Harm arises or results, directly or indirectly, from the negligence of the Federation or the Competition. I AGREE to expressly assume all risks of Harm to me or my horse, including Harm resulting from the negligence of the Federation or the Competition. I AGREE to indemnify (that is, to pay any losses, damages, or costs incurred by) the Federation and the Competition and to hold them harmless with respect to claims for Harm to me or my horse, and for claims made by others for any Harm caused by me or my horse while at the Competition. I have read the Federation Rules about protective equipment, including GR801 and, if applicable, EV114, and I understand that I am entitled to wear protective equipment without penalty, and I acknowledge that the Federation strongly encourages me to do so while WARNING that no protective equipment can guard against all injuries. If I am a parent or guardian of a junior exhibitor, I consent to the child’s participation and AGREE to all of the above provisions and AGREE to assume all of the obligations of this Release on the child’s behalf. I represent that I have the requisite training, coaching and abilities to safely compete in this competition. I AGREE that if I am injured at this competition, the medical personnel treating my injuries may provide information on my injury and treatment to the Federation on the official USEF accident/injury report form. BY SIGNING BELOW, I AGREE to be bound by all applicable Federation Rules and all terms and provisions of this entry blank.

Fees #_________ Stalls @ $185 #_________ Stalls after 1/22 @ $200 USEF Non Member Amateur Card $30 USEF JR Non-Member Fee $30 USEF SR Non-Member Fee $30 USHJA Non-Member Fee $30 USEF Drug Fee $7+ USEF Fee $8

$15

USHJA Zone Support Fee @ $2 Office Fee $50 Non-Showing Fee $100 Grounds Fee $50 Late Fee $35 Nominating Fee $150 Reserve Campers on the Enclosed Form Order Shavings/Feed/Hay on the Enclosed Form

$2

Emergency Phone Contact_________________________ Rider/Handler (Mandatory) Signature:

Owner/Agent (Mandatory) Signature:

Trainer (Mandatory) Signature:

Coach (If Applicable) or Rider #2 Signature:

Print Name:

Print Name:

Print Name:

Print Name:

Parent/Guardian Signature (required if Rider/Driver/Handler/Vaulter/Longeur Is a Minor) Emergency Phone Contact_____________________________ Print Parent/Guardian Name:_______________________Parent/Guardian Signature:_________________________Is rider a US citizen?_____________

Total Enclosed

*Office Use Only


Entry #

Great Southwest Winter Series II, February 10-14, 2010 Great Southwest Equestrian Center Entry Deadline is January 22, 2010

Horse Information Name:

Green

Color

Height

USEF #/USHJA# THJA# # 1-Rider Information Name: Address: City, State, Zip: Phone # Social Security # DOB/Age: ASPCA# USEF#/USHJA# THJA#

Age

Owner Information Name: Address: City, State, Zip: Phone# Social Security # USEF#/USHJA# THJA# #2 Rider Information Name: Address: City, State, Zip: Phone # Social Security # DOB/Age: ASPCA# USEF#/USHJA# THJA# Federation Entry Agreement

Trainer Information Name: Address: City, State, Zip: Phone # USEF#/USHJA# THJA# Social Security # Barn Name: Alternate Payee for Prize Money Name: Address: City, State, Zip: Phone # SSN#

I have read the United States Equestrian Federation, Inc. (the “Federation”) Entry Agreement (GR906.4) as printed in the Prize List for the Great Southwest Winter Series II, and agree to all of its provisions. I understand and agree that by entering this Competition, I am subject to Federation Rules, Prize List, and local rules of the competition. I agree to waive the right to the use of my photos from the competition, and agree that any actions against the Federation must be brought in New York State.

Mail Entries To: Pauline Cook/Great Southwest Equestrian Center 2501 South Mason Road, Suite 100 Katy, TX 77450 281-579-1272

Division Entry Information *Please Circle Divisions & Indicate Rider # Wrk Htr___ 1st Y Grn__ 3’6” A/O __ Rg Conf____ 2nd Y Grn__ 3’3” A/O___ Grn Conf__ Sm Jr 15/U_ Sm Jr 16/17___ Lg Jr 15/U____ L Jr 16/17_ Ch Pony___ Sm Pony___ Md Pony__ Lg Pony___ A/A 18/35__ Gr Pny/L__ Gr Pny/SM___ A/A 36/49__ Ch 14/U___ 3’ Pre Gr___ A/A 50/O__ Ch 15/17__ 3’3” Pre Gr___ Baby Gr____ S/L Str Htr___ EQ___ Sp Htr___ Mod Htr___ Mod C/A___ Jumpers: M .95____ M 1.0 _____ M 1.15____ M 1.25___ M 1.35___ J/A Low__ J/A High___ C/A Low___ A High___ C High___ Equitation: Open/Low Classes: Individual Classes/Classics: Stable With:

Federation Release, Assumption of Risk, Waiver, and Indemnification This document waives important legal rights. Read it carefully before signing. I AGREE in consideration for my participation in this Competition, the Great Southwest Winter Series II, to the following: I AGREE that “the Federation” and “Competition” as used herein includes the Licensee and Competition Management, as well as all of their officials, officers, directors, employees, agents, personnel, volunteers and Federation affiliates. I AGREE that I choose to participate voluntarily in the Competition with my horse, as a rider, driver, handler, vaulter, longeur, lessee, owner, agent, coach, trainer, or as parent or guardian of a junior exhibitor. I am fully aware and acknowledge that horse sports and the Competition involve inherent dangerous risks of accident, loss, and serious bodily injury including broken bones, head injuries, trauma, pain, suffering, or death. (“Harm”). I AGREE to hold harmless and release the Federation and the Competition from all claims for money damages or otherwise for any Harm to me or my horse and for any Harm of any nature caused by me or my horse to others, even if the Harm arises or results, directly or indirectly, from the negligence of the Federation or the Competition. I AGREE to expressly assume all risks of Harm to me or my horse, including Harm resulting from the negligence of the Federation or the Competition. I AGREE to indemnify (that is, to pay any losses, damages, or costs incurred by) the Federation and the Competition and to hold them harmless with respect to claims for Harm to me or my horse, and for claims made by others for any Harm caused by me or my horse while at the Competition. I have read the Federation Rules about protective equipment, including GR801 and, if applicable, EV114, and I understand that I am entitled to wear protective equipment without penalty, and I acknowledge that the Federation strongly encourages me to do so while WARNING that no protective equipment can guard against all injuries. If I am a parent or guardian of a junior exhibitor, I consent to the child’s participation and AGREE to all of the above provisions and AGREE to assume all of the obligations of this Release on the child’s behalf. I represent that I have the requisite training, coaching and abilities to safely compete in this competition. I AGREE that if I am injured at this competition, the medical personnel treating my injuries may provide information on my injury and treatment to the Federation on the official USEF accident/injury report form. BY SIGNING BELOW, I AGREE to be bound by all applicable Federation Rules and all terms and provisions of this entry blank.

Fees #_________ Stalls @ $185 #_________ Stalls after 1/22 @ $200 USEF Non Member Amateur Card $30 USEF JR Non-Member Fee $30 USEF SR Non-Member Fee $30 USHJA Non-Member Fee $30 USEF Drug Fee $7+ USEF Fee $8

$15

USHJA Zone Support Fee @ $2 Office Fee $50 Non-Showing Fee $100 Grounds Fee $50 Late Fee $35 Nominating Fee $150 Reserve Campers on the Enclosed Form Order Shavings/Feed/Hay on the Enclosed Form

$2

Emergency Phone Contact_________________________ Rider/Handler (Mandatory) Signature:

Owner/Agent (Mandatory) Signature:

Trainer (Mandatory) Signature:

Coach (If Applicable) or Rider #2 Signature:

Print Name:

Print Name:

Print Name:

Print Name:

Parent/Guardian Signature (required if Rider/Driver/Handler/Vaulter/Longeur Is a Minor) Emergency Phone Contact_____________________________ Print Parent/Guardian Name:_______________________Parent/Guardian Signature:_________________________Is rider a US citizen?_____________

Total Enclosed

*Office Use Only


STALL REQUEST FORM

RV Reservation Form Blue Ribbon Winter Festival & Winter Warm Up • •

• • •

Camper spaces are available on a first come, first serve basis. NO RESERVATIONS WILL BE TAKEN WITHOUT PAYMENT IN FULL. Hookups cost $200 per week CAMPERS MAY NOT BE PARKED WITHOUT FIRST CHECKING IN AT THE HORSE SHOW OFFICE. Campers may be parked no earlier than Monday, January 18, and must be off the property no later than Monday, January 31. Arrangements for early arrivals and/or late departures can be accommodated however there will be an additional per day charge. Please contact Patrick Rodes at 940-240-1207 for more information and to reserve additional nights.

Name: Barn/Trainer Name: Phone Contact (Prior to Show): Phone Contact (During Show): Address: Type of RV: AMPS Desired: Date of Arrival:

Length of RV: 50 AMP 30 AMP Date of Departure:

Camper Site @ $200 per week $ (Please make checks payable to Southbound Show Management)

Blue Ribbon Winter Festival, # of Stalls The Winter Warm Up, # of Stalls

Barn Name: Trainer Name: Please list all clients you want stabled with your group in the space below. Horse

Owner

# Stalls

Week 1

2

# Shavings

Hay

Feed

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Please complete and return to: Southbound Show Management 785 W. Jeter Road Argyle, TX 76226

Notice: All forms must be signed. All changes must be made in writing.

Questions: (940) 240-1207 or pdrntx@aol.com

Signature: Phone Contact:

Trainer splits must be received by 12 PM Friday. No splits will be accepted after that time.

Date:


STALL REQUEST FORM

RV Reservation Form Great Southwest Winter Series I & II • •

• • •

Camper spaces are available on a first come, first serve basis. NO RESERVATIONS WILL BE TAKEN WITHOUT PAYMENT IN FULL. Hookups cost $250 per week including pump out. CAMPERS MAY NOT BE PARKED WITHOUT FIRST CHECKING IN AT THE HORSE SHOW OFFICE. Campers may be parked no earlier than Monday, February 1, and must be off the property no later than Monday, February 15. Arrangements for early arrivals and/or late departures can be accommodated however there will be an additional per day charge. Please contact Pauline “Cookie” Cook at 281-5791272 for more information and to reserve additional nights.

Name: Barn/Trainer Name: Phone Contact (Prior to Show): Phone Contact (During Show): Address: Type of RV: AMPS Desired: Date of Arrival:

Length of RV: 50 AMP 30 AMP Date of Departure:

Camper Site @ $250 per week $ (Please make checks payable to Great Southwest Equestrian Center)

Please complete and return to: Pauline “Cookie” Cook Great Southwest Equestrian Center 2501 South Mason Road, Suite 100 Katy, TX 77450 Questions: 281-579-1272 or cookie143@hughes.net

Great Southwest Winter Series I, # of Stalls Great Southwest Winter Series II, # of Stalls

Barn Name: Trainer Name: Please list all clients you want stabled with your group in the space below. Horse

Owner

# Stalls

Week 1

2

# Shavings

Hay

Feed

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Notice: All forms must be signed. All changes must be made in writing. Trainer splits must be received by 12 PM Friday. No splits will be accepted after that time.

Signature: Phone Contact:

Date:


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