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NO ADDRESS.NO PAYCHECK PAYEE: Rider or Owner

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THE STAMPEDE SHOW & DERBY ENTRY _________
YOUNG COUNTY ARENA, GRAHM, TX
May 6-9, 2021
Account Name: _________________________________________________ Trainer: ____________________________
NRHA Horse’s Name ____________________________________________ Comp Lic # ______________ S G M
Horse’s Barn Name ____________________________ Foaled: ____
Owner’s Name _________________________________________________ NRHA # ________________ G A NP Y L
Rider’s Name __________________________________________________ NRHA # ________________ P A NP Y L
NO ADDRESS….NO PAYCHECK PAYEE: Rider or Owner
Address_____________________________________________________ City ____________________ State____ Zip ___________
Phone (______) _________________________E-mail _______________________________________________________________
Class Order Division EF JF Rider Pattern
Thurs 5/6 Approx start 30min after PWU
1
st
1700 NH Open L1 (JP) 25 25 ___________________________ NRHA# ____________ 2
1750 NH Open L2 (250) 25
1775 NH Open L3 (300) 30
1800 NH NP L1 (JP) 25
1850 NH NP L2 (250) 25
1875 NH NP L3 (300) 30
Friday 5/7
1
st
9003 Mens (JP) 40 25 ___________________________ NRHA#____________ 13
9004 Ladies (JP) 40
2
nd
1100 Open (450) 45 25 __________________________ NRHA# _____________ 8
1200 Int Open (300) 30
1301 Ltd Open (250) 25
1350 Rookie Pro (JP) 30
Saturday 5/8
1
st
10001 Grn Level 2 30 0 __________________________ NRHA# ____________ 4
10002 Grn Level 1 30
10003 WTRHA PT Green (JP) 30 (Must be a WTRHA 2021 member & Cross enter)
2
nd
1400 Non Pro (450) 45 25 __________________________ NRHA# _____________ 4
1500 Int NP (300) 30
1600 Ltd NP (250) 25
1650 PT NP (250) 25
5121 Master (250) 25
3
rd
9600 Green Horse (SCH) 35 25 __________________________ NRHA# _____________ 11
Sunday 5/9
1
st
3100 Youth 13 & Under 10 0 ______________________________ NRHA# _____________ 6
3200 Youth 14-18 10 AQHA# _____________
2
nd
3500 Short Stirrup 10 0 ______________________________ NRHA# _____________ A
3
rd
9918 Walk Trot 10 0 ______________________________ NRHA# _____________
9919 Lead Line 10
Cc# _________________________________________ Exp _________ CVC ________ Zip __________
Horse Name ____________________________________________ ENTRY __________
4
th
5300 Rookie L1 (JP) 20 20 ______________________________ NRHA# ______________ 5
5301 PT Rookie (JP) 20
5310 Rookie L2 (JP) 20
9918 WTRHA Nov Rider (JP) 25 (Must be a 2021 member of WTRHA and cross to a NRHA division)
5
th
2400 NP L4 Derby (1250) 120 60 ______________________________ NRHA# _____________ 16
2600 NP L2 Derby (750) 70
6
th
2100
Op L4 Derby (1250) 120 60 _____________________________ NRHA# _____________ 16
2300 Op L2 Derby (750) 70
Entry Fee Total -- - - - - - - - - - - - - - - - - - - - - ________
Judges Fee Total - - - - - - - - - - - - - - - - - - - - ________
Office Fee $45 per horse - - - - - - - - - - - - - - - ___45___
______Stalls x ____nights $45/night- - - - - - - ________
Shavings _______ x $12/ bag - - - - - - - - - - - - ________
Grounds Fee ______$40/day un-stalled horse - ________
RV nights_____ x $45/night - - - - - - - - - - - - - ________
Paid Warmups _______ x $40- - - - - - - - - - - ________
NRHA Fee $7/horse - - - - - - - - - - - - - - - - - - ____7___
Affiliate Contribution $5/horse - - - - - - - - - - - ____5___
5% CC ________ Cash Disc _______- - - - - - - - - - ________
Final Total - - - - - - - - - ________
Sign ___________________________________________________ Date _______________
Cash __________
CC __________
Chk # _________
$_________
_
May Checks Payable to:
Stampede Show
WARNING: Under Texas Law (Chapter 87, Civil Practice and Remedies Code), a farm animal professional is not liable for an injury
to or the death of a participant in farm animal activities resulting from the inherent risks of farm animal activities. I further
understand that all horses must be stalled due to facility requirement. Horses are not allowed to be tied to trailers for extended periods
or overnight. I will abide by this requirement.
RELEASE OF LIABILITY: By making an entry in this show, participant agrees to release Mark Miller dba: The Stampede Show and
Harrel Show Secretary from liability resulting from risks inherent in equine activities.
CREDIT CARD: By signing this form you agree to pay charges for service with above mentioned CC information.
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NO ADDRESS.NO PAYCHECK PAYEE: Rider or Owner

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Completed 4 May 2021

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