Text Box: Name:_________________________________________________________Reg. #___________________ Sex:   q  Stallion    q Gelding       q   Filly               Foaling Date_________________________ Sire:______________________________________________________Registration #________________ Dam:______________________________________________________Registration #_________________   Owner’s Name____________________________________________________________________________________ Address_______________________________________________________________________________________________ City, State, Zip Code______________________________________________________________________________ Telephone #_________________________________________Email_______________________________________ Social Security Number___________________________________________________________________________          q  IN DAM NOMINATION        q  NON-NOMINATED ENTRY

Text Box: Mail Entries & Payments To: Lisa Langhorst 578 Ashland Rd Ashland, NE 68003 llanghorst@windstream.net

Text Box: ** Entries made after deadline are double the above fees.

Text Box: Please print a separate copy of this form for each horse you are entering.

Text Box: Des Moines, Iowa

CHECK BOX

CLASS

IN-DAM

NOMINATION

NON-NOMINATED FEE

ENTRY FEE DEADLINE

 

2-Year-Old WESTERN PLEASURE

$50.00

$ 100.00

JUNE 15 **

 

2-Year-Old ENGLISH PLEASURE

$50.00

$100.00

JUNE 15 **