Free State All Breed Show Pre-Entry Form
Show Date: May 6, 2007 Entry # __________
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Horse Name (Must match name on Coggins) |
Age |
Gender |
Height |
Color |
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Owner(s)
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Coggins Certificate |
Date |
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Address (street, city, state, and zip) |
Telephone Number
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Class |
Class |
Class |
Class |
Exhibitor Name: Last, First MI |
Address if different from above |
Date of Birth |
Release Signed |
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| Total Number of Entries ______ X $10.00 = $_________ |
Free Sate ApHC Membership: |
| Free State ApHC Entries ______ X $ 8.00 = $_________ | Youth $10.00 ___________ |
| Office Fee $ 5.00 = $_________ | Adult $15.00 ___________ |
| EMT Fee $3.00 = $__________ |
Family $25.00 __________ |
| Mini Series Championship Fee $10.00 = $__________ | |
| 3-D Barrell Race Fee $30.00 = $__________ | TOTAL: |
| Number of stalls _____ X $35.00 = $__________ | CK#____________ |
| Camper hookup $30.00 =$ __________ | CASH________________ |
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