25th
UPHA
CHAPTER 9 KENTUCKY FALL CLASSIC HORSE SHOW
ACADEMY ENTRY FORM
October
6, 2012
Kentucky Horse
Park, Lexington, Kentucky
Entries close October 2, 2012
One Horse per entry Blank Mail
To: Kentucky Fall Classic Horse Show
Make checks payable to: 65
Old Taylorsville Road
Kentucky Fall Classic Horse Show Shelbyville,
KY 40065
Entries may be paid by credit card
below Phone
(502) 647-0076 or Fax (502) 633-6207
PLEASE PRINT OR TYPE (Fill out
completely)
Owner______________________________________ _______________________________ ________________
Address_____________________________________________________ City/State/Zip_____________________
Trainer/Instructor_____________________________ _______________________________ Stable__________
Address_____________________________________________________ City/State/Zip__________________
Phone
#______________________________ Cell
Phone #__________________________
email_____________
Signature_____________________________________________________________________________________
|
|
Office Use Only
|
Class
|
Rider/Handler
|
Age
|
City/State
|
Fee
|
|
1
|
|
|
|
|
|
|
|
2
|
|
|
|
|
|
|
|
3
|
|
|
|
|
|
|
|
4
|
|
|
|
|
|
|
|
5
|
|
|
|
|
|
|
|
6
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
Entry Fees
|
|
I
hereby enter the above horses and riders at my own risk and subject to the
rules and regulations of the Show. I further agree that if any damage is
occasioned or loss occurs to the horses exhibited, to any vehicle or other
articles which I may send with said horses, I will make no claim therefore
against the Kentucky Fall Classic Horse Show or any participating organizations.
|
|
TOTAL
ENTRY FEES
|
$
|
|
#
|
STALLS
@ $125 EACH (week)
|
$
|
|
#
|
STALLS
$40 PER DAY (including EARLY SHIP IN)
|
$
|
|
#
|
GROUNDS
FEE (Horses showing not using a stall) @ $15
|
$
|
|
#
|
OFFICE
FEE PER ENTRY
|
$
10.00
|
|
|
TOTAL
REMITTANCE
|
$
|
CHECK #________AMOUNT $______________ DATE RECEIVED_________WE ALSO ACCEPT: VISA________ MASTER CARD__________
CARD #_______________________________________________EXPIRATION DATE____________SECURITY CODE_____________
CARD HOLDER NAME (please print)_______________________________CARD HOLDER SIGNATURE__________________________
ALL HORSES MUST HAVE NEGATIVE COGGINS
TEST PERFORMED WITHIN 12 MONTHS OF SHOW, AND HEALTH PAPERS FOR ALL HORSES
CURRENT WITHIN 30 DAYS
CHECK #_________ AMOUNT $___________________________ DATE RECEIVED________________
