Horse Name
Year Foaled
Sex
Pick One
Mare
Gelding
Stallion
Breed
NWHA Registration
#
Other Registration
#
Coggins Date
Owner Information
Owner Full Name
Ranch/Farm Name
NWHA Membership #
Address
City
State, Zip
Home Phone Plus
Area Code
Work Phone Plus
Area Code
Mobile Phone Plus
Area Code
E-Mail
Exhibitor
Information
Exhibitor A Full Name
Youth or Adult
-NWHA # - Phone #
Pick One
Youth
Adult
E-mail
Classes Entering
Example: 1, 5, 8, 22, 45, 66
Exhibitor B Full Name
Youth or Adult
-NWHA # - Phone #
Pick One
Youth
Adult
E-mail
Classes Entering
Example:
1, 5, 8, 22, 45, 66
Exhibitor C Full Name
Youth or Adult
-NWHA # - Phone #
Pick One
Youth
Adult
E-mail
Classes Entering
Example:
1, 5, 8, 22, 45, 66
Fee
Information
20 Class Special
$225.00
Single Class Fee:
number of classes
x $25=
Stall - Select 1,
2 or 3 days
No Stalls
Stall 1 Day $25
Stall 2 Day $40
Stall 3 Day $50
DQP Fee Per
Horse/Per day # days
0
1
2
x $15=
$15
$30
Grounds Fee (if no
stall paid) $12
Office Fee (per
horse) $5
Wood Chips # bags
0
1
2
3
4
5
6
7
8
9
10
11
12
x $6=
RV Hook-up #
night(s)
0
1
2
3
4
x $15=
Amateur Card for
show ($5) For the Year (15)
NWHA Membership
($50)
Total Amount
Comments or
instructions
