2011 Moon Walker
Memorial Horse Show
Horse's 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
Trainer
Trainer Full Name
Ranch/Farm Name
NWHA Membership #
Address
City
State, Zip
Home Phone Plus
Area Code
Mobile Phone Plus
Area Code
E-Mail
Exhibitor
Information
Exhibitor A Full Name
Address
City
State, Zip
Youth or Adult
-NWHA # - Phone #
Pick One
Youth
Adult
E-mail
Classes Entering
Example: 1, 5, 8, 22, 45, 66
Exhibitor B Full Name
Address
City
State, Zip
Youth or Adult
-NWHA # - Phone #
Pick One
Youth
Adult
E-mail
Classes Entering
Example:
1, 5, 8, 22, 45, 66
Exhibitor C Full Name
Address
City
State, Zip
Youth or Adult
-NWHA # - Phone #
Pick One
Youth
Adult
E-mail
Classes Entering
Example:
1, 5, 8, 22, 45, 66
Fee
Information
Participating in
the Dressage Clinic
Yes or No.
Name into drawing
for Exhibitor Judge
Yes of No
Single Class Fee:
number of classes
x $22= Pre entry price! $25 at show.
Championship Class
x $30=
$35 at show.
Stall - Select 1,
2 or 3 days
No Stalls
Stall 1 Day $30
Stall 2 Day $40
Stall 3 Day $50
Tack Stall
No Tack Stall
Tack Stall 1 day $30
Tack Stall 2 days $40
Tack Stall 3 days $50
Shavings $7
Number of
shavings
DQP Fee Per
Horse/Per day # days
0
1
2
x $12=
$12
$24
Grounds Fee (if no
stall paid) $15
Office Fee (per
horse) $8
$8
RV Hook-up #
night(s)
0
1
2
3
4
x $20=
NWHA Show Pass
good for 4 days ($15) Season Pass ($40)
NWHA Membership
($60)
Total Amount
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Comments or
instructions
