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THE STAMPEDE SHOW DERBY & STAKES (Harrel Show Secretary)

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ENTRY ___________
THE STAMPEDE SHOW DERBY & STAKES
NRHA – AQHA – WTRHA APPROVED
March 18-21, 2021
Account Name: _____________________________________ Trainer: ___________________________
(Person Responsible for Paying)
NRHA Horse’s Name _____________________________________ Comp # ________________ S G M
Horse’s Barn Name ____________________________________ AQHA # _______________ Yr Foaled _________
Owner’s Name ______________________________________ NRHA # ________________ G A P NP A Y L
Payee NO ADDRESS….NO PAYCHECK AQHA # ________________ O AM N Y L
Owner’s Name ______________________________________ NRHA # ________________ G A P NP A Y L
Payee AQHA # ________________ O AM N Y L
Rider’s Name ______________________________________ NRHA # ________________ P A NP A Y L
Payee NO ADDRESS….NO PAYCHECK AQHA # ________________ O AM N Y L
Address_________________________________________________ City _____________________ State______ Zip ___________
Phone (______) ____________________ E-mail ____________________________________________________________
Class Division Entry Judges
Order Class # Fee Fee Rider Pattern #
Thursday 3/18 Approx start time 30 min after PWU (Only one Judges Fee for ALL Concurrent Classes – Highest fee applies)
1
st
1700 Nov Hor Op L1 (JP) 25 25 _____________________ NRHA# ___________ 14
1750 30
1775 35
1800 25
1850 30
1875
Nov Hor Op L2 ($300)
Nov Hor Op L3 ($350)
Nov Hor NP L1 (JP)
Nov Hor NP L2 ($300)
Nov Hor NP L3 ($350)
35
Friday 3/19 Starting at 8:00 am
1
st
9003 Ladies (JP) 40 25 ________________________ NRHA #____________ 11
9004 Mens (JP) 40
2
nd
1100 Open ($450) 45 25 _______________________ NRHA# ____________ 6
1200 Int Open ($350) 35
1301 Ltd. Open ($300) 30
1340 AQHA Open 50 0 _______________________ AQHA # ___________
1350 Rookie Pro (JP) 30
Saturday, 3/20 Starting at 8:00 am
1
st
9913 Green Horse (Schooling) 40 25 ______________________ NRHA# _________ 13
2
nd
2342 AQHA Nov Am 40 0 ________________________ AQHA #____________ 8
5300 Rookie L1 (JP) 20 20 ________________________ NRHA #____________
5301 PT Rookie (JP) 20
5310 Rookie L2 (JP) 20
9918 WTRHA Nov Rider 25 must a member of WTRHA and cross enter
3
rd
3100 Yth 13 & < 10 0 _______________________ NRHA #____________ 13
3200 Yth 14–18 10
4347 AQHA Yth 13 & < 10 ________________________ AQHA # ____________
4348 AQHA Yth 14-18 10
4
th
3500 10&< Yth Sht Stup 10 0 ________________________ NRHA #_____________ A
HORSE NAME __________________________________________________________ ENTRY # _____________
5
th
Sunday, 3/21 Starting at 8:30 am
1
st
9919 Lead Line 10 0 ________________________ NRHA # _____________
9926 Walk Trot 10
2
nd
10001 Green Rider L2 30 0 ________________________ NRHA #_____________ 13
10002 Green Rider L1 30
10003 WTRHA PT Green 30
3
rd
1400 Non Pro ($450) 45 25 ________________________ NRHA #_____________ 2
1500 Int NP ($350) 35
1600 Ltd NP ($300) 30
1650 PT Non Pro ($250) 25
2340 AQHA Am 50 0 ________________________ AQHA# _____________
5121 Masters Non Pro ($250) 25 25
4
th
OPEN DERBY - STAKES
2100 Op Derby L4 ($1900) 180 65 ________________________ NRHA #_____________ 3
2300 Op Derby L2 ($900) 85
9302 L4 Op Stakes ($1100) 100
DO NOT WRITE BELSOW THIS LINE FOR OFFICE USE ONLY DO NOT WRITE BELSOW THIS LINE FOR OFFICE USE ONLY
Entry fee total - - - - - - - - - - - - - - = ________ ________
Judges fee total - - - - - - - - - - - - - - = ________ ________
Office fee $ 45 (N/C if youth only classes) - = ___45___ ___45___
Stalls _____x _____ Nights/$45- - - - - - -= ________ ________
Shavings ______x $12/bag - - - - - - - - - = ________ ________
RV #_____ x _____ Nights /$45 - - - - - - -= ________ ________
Grounds fee $35/day/un-stalled horse - - - = ________ ________
Paid Warm Ups _______ X $40 for 7 min - = ________ ________
NRHA Drug Fee..$7/horse - - - - _- - - = ________ ________
AQHA Drug _____ $8/horse- - - - - - - - - - - -= ________ ________
Affiliate Contribution $5/horse- - - - - - - - - - - - - = __________ _________
5% Chg CC____ Disc Cash ____ - - - - - - - - - - - = __________ _________
FINAL TOTAL - - - - - - - - - - -= _________ _________
Name ___________________________________________________________________________________
CC# ____________________________________________ Exp Date ___________ CCV______ Visa M/C
Signature: _________________________________________________ Date ________________________
Check # _______ Check $________ Cash $________ Cr Card $ _________
Checks payable to: Stampede Show
NON PRO DERBY-STAKES
2400 Non Pro Derby L4 ($1900) 180 65 ________________________ NRHA# ______________ 3
2600 Non Pro Derby L2 ($900) 85
9303 L4 NP Stakes ($1100) 100
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.
VIDEO/PHOTOGRAPHY: By
entering this show the
exhibitor/owner agrees and
consents to the NRHA rules
concerning photos and video.
CREDIT CARD: By signing this
form you agree to pay charges
for service with above mentioned
CC information.
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THE STAMPEDE SHOW DERBY & STAKES (Harrel Show Secretary)

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Completed 6 May 2021

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