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Montana Gold Futurity Entry Form
October 3, 2009
Circle L Arena, 4350 Spain Bridge Road, Belgrade, MT
8:00 am
Mail to: Maria Jerome, MGF Secretary
455 Bluegrass Dr.Belgrade, MT 59714
Exhibitors Name_________________________________________________________
Owners Name_______________________________________________________
Owners Address__________________________________City__________________
State____________________Zip____________________Phone_____________________
Please send a copy of card and horses registration, or reg. application and work order # for weanlings only, with entry. Use one form per horse. Horses Registered Name______________________________________________________________ Registration #____________________ Year foaled_________ Sex Mare Gelding Stallion Sire_____________________________________Dam____________________________________
Circle Class numbers to be entered:
1 2 3 4 6 7 8 9 12 22 31 33
Make additional copies of entry form for each horse. Make Checks payable to Montana Gold Futurity, LLC
$40.00/class X ___________ = __________
$50.00/class late fee (after 9-18-2009 through 9-30-2009) X #__________classes = ______
Stall (panel $20.00, panel with cover $25.00 or boxstall $30.00)
Office Charge $10.00
Total
Waiver: In consideration of my participation in the above event, I, my heirs, executors and administrators, hereby release the Montana Gold Futurity, Circle L Arena and any sponsors from any responsibility for injury to me, my stock, or my equipment during any participation or arising out of my participation in the above event and from every collecting damages for the above risks or actions taken in connection with the above eventSignature______________________________________________________________Date______________
Guardian Signature if under 18______________________________________________
Date of Birth for youth__________________________ Please send a copy of card and horses registration papers with entry.
Registration #____________________ Year foaled_________ Solid Overo Tobiano Tovero Sex Mare Gelding Stallion
5 10 11 13 14 15 16 17 18 19 2 21 23 24 25 26 27 28 29 30 32 34 35 36 37 38 39 40 41
42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70
71 72 73 74 75 76 77
Class Fee: Solid Paint Bred $ 6.00/class Youth $7.00/class Open and Amateur $11.00/class Walk Trot 5-9 $6.00/class APHA fees: One time fee of $ 2.00/horse Office Charge $10.00/horse (if the horse was entered in the futurity do not pay again) Stalls: Weekend $20.00/night-day for panels$25.00/night-day covered panels, and $30.00/night-day for boxstalls
Make additional copies of entry form for each horse Make Checks payable to Rod Cline