Great Escape Winter Slide 2012 NRHA, TRHA, & AQHA – Alliance Event
ENTRY # _________
March 2 – 4, 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 #
Friday, Mar 2nd, Starting at 8:00 am 1100 Open ($700) 1st Int Open ($350) 1200 Ltd Open ($250) 1301 AQHA Op Rn 1340
Entry Judges Fee Fee
Rider (if different from above)
Pattern #
70 35 25 35
25 25 20 0
________________________ NRHA #__________
________________________ AQHA #__________
Office Use Only
6
G NP Y O AM N Y
2nd
5850
Int Hor NP ($250)
25
20
________________________ NRHA #__________
9
NP YNP
3rd
10002 10001
Green Level I Green Level II
20 20
0
________________________ NRHA #__________
4
NP
Saturday, Mar 3rd , Starting at 8:00 am 1700 Nov Hor Op L1($200) 20 1st Nov Hor Op L2($250) 25 1750
20
________________________ NRHA #__________
5
G NP Y
2nd
1800 1850
Nov Hor NP L1 ($200) 20 Nov Hor NP L2 ($250) 25
20
________________________ NRHA #__________
8
NP Only
3rd
3500
Yth 10 & < Short Stir
10
0
________________________ NRHA #__________
12 Y YNP
4th
3100 3200
Yth 13 & < Yth 14–18
10 10
0
________________________ NRHA #__________
2
4347 4348
AQHA 13 & U AQHA 14 – 18
10 10
5300 9801
Rookie I (JP) 20 TRHA $1000 Rider (JP) 20
5th
Y
________________________ AQHA #__________ 20
________________________ NRHA #__________ ________________________ TRHA Member
Y YNP
8
NP Y NP TRHA
Horse Name____________________________________
ENTRY # _________
Sunday, Mar 4th Starting at 8:00 am 1st
NP only
1400 1500 1600 1650 2340 2348
Non Pro ($700) 70 25 ________________________ NRHA #__________ Int NP ($350) 35 25 Ltd NP ($200) 20 20 PT N Pro ($200) 20 AQHA Am Rein* 35 0 ________________________ AQHA #__________ AQHA Am Select* 35 (*AQHA Riders may enter only Amateur or Amateur Select – NOT Both)
8
2nd
5301 5310
Prime Time Rookie (JP) 20 Rookie II (JP) 20
20
________________________ NRHA #__________
4
3rd
5750
Int Hor OP ($250)
20
________________________ NRHA #__________
10 G Y
25
AM or AM SEL NP Y
(Only one Judges Fee for Concurrent Classes – Highest fee applies) Charges
Checks payable to: Great Southwest Eq Cntr
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 (2/28-3/3) - - - - - =________ Early Arrival (Mon 2/27) $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 - - - - - =________ (must be purchased from GSWEC) Paid Warm Ups _____X $25 for 8 min - - - - - - =________ Schooling Class _____X $40 for 6 min - - - - - - =________ RV Space ______ X $30 per ____ Nights - - - - =________ AQHA Drug Testing $5.00/horse/show - - - - - =________
FINAL TOTAL =
_________
________ ________ ___25___
________ ________ ___25___
________ ________ ________ ________ ________ ________ ________
________ ________ ________ ________ ________ ________ ________
________ ________ ________ ________
________ ________ ________ ________
_________
_________
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: March_____, 2012