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DATE: _____________
RIDER: _________________________
PHONE: _______________
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# OF HORSES ENTERING BARRELS: ______ (X $30) = $__________
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# OF HORSES ENTERING POLES: ______ (X $30) = $__________
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OFFICE CHARGE:
$___1.00___
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ARENA FEE ($5): per contestant
$__________
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LATE ENTRY FEE ($10):
(entries close 1/2 hr before scheduled race start)
$__________
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NON-SSBPA MEMBER INSURANCE FEE ($5):
$__________
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# OF BARREL TIME ONLY'S (one minute each):
______ (X $4) = $__________
# OF POLE TIME ONLY'S (2 times thru course)
(only offered at facilities with two arenas):
______ (X $4) = $__________
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# OF HORSES ENTERING AMERICA WEST
(must enter SSBPA race):
______ (X $4) = $__________
AMERICA WEST #: ________________________
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TOTAL:
= $____________________
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In submitting my entry, I hereby release the Silver State Barrel and Pole Association, its officers and directors, the event organizers and facility owners, and anyone else associated with this event from any claims for any losses or damages, which may occur to me, my child, my horse, or any other property at this event. (Contestants under the age of 18 must have parent or guardian sign entry form.)
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SIGNATURE_________________________________________________________
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PRINTED NAME______________________________________________________
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