Horse’s Name Reg. No. DOB MM/DD/YY Sex Color

Breed

A HA AA

Sire Dam

Rider 1 Classes

Name DOB MM/DD/YY Amateur Certificate Yes No

AHA # Amateur Relationship to horse owner

Address City State Zip

Rider 2 Classes

Name DOB MM/DD/YY Amateur Certificate Yes No

AHA# Amateur Relationship to horse owner

Address City State Zip

Rider 3 Classes

Name DOB MM/DD/YY Amateur Certificate Yes No

AHA# Amateur Relationship to horse owner

Address City State Zip

OWNER INFORMATION Owner name as it appears on registration papers/purchase contract

Name _____________________________________________________________________________

AHA# ____________________________ Farm/Ranch______________________________________

Current Address_______________________________________________ Phone________________

City________________________________________ State ________________ Zip_______________

Email______________________________________________________________________________

TRAINER INFORMATION (Must be filled out. If there is no trainer, please use owner info)

Name _____________________________________________________________________________

AHA#______________________________________ USEF/EC#______________________________

Address_______________________________________________ Phone______________________

City______________________________________State ____________________Zip ____________

Email_____________________________________________________________________________

USE STALL FORM FOR STALLS, STABLING REQUESTS,

SHAVINGS, HAY, AND CAMPING.

SEND TO: Cheri Clark

6723 E Daisy Dr. Black Hawk, SD 57718 showringcc@aol.com

406-581-0232

Preshow Entry Form – June 23-24, 2020 Please include a copy of the horse’s registration papers and owner/trainer/exhibitor AHA Competition Membership cards.

Include dressage classes and fees on this form.

Class Fee - $25 x # of classes______ $_______

Training Tack Classes - $25 x # of classes_____ $_______

Walk/Trot & Equitation - $20 x # of classes_____ $_______

TBA Class - $30 (Plus class fee) x # of classes____ $_______

AHA Single Event Membership - $35 $_______

AHA Resolution 9-90 - $5 $___5___

AHA Results Reporting - $5 $___5___

Patron: $300/$500/$700 $_______

*Office fee is calculated on the Regional Entry Form.*

*Late Entry Fee calculated on the Regional Entry Form.*

Total: $_______

Please make checks payable to: Region 6 AHA

Credit card payments will be accepted at the show (swipe only). Credit card payments will incur a 3% processing fee. If you are planning to pay by credit card, please submit a blank check with your entries.

Your check will be held at the office and returned to you after your credit card payment has been

made.

Entries may be submitted via e-mail (no pictures of entries please)

or USPS. Entries must be postmarked or e-mailed on or before

June 5. Post entries will be accepted. Entries postmarked or

received after June 5 will be assessed a $100 late fee. Post entries

will NOT be accepted for dressage.

*Please note that classes can be added after June 5 at no additional

charge. Exhibitors that send in their entries and do not attend the

show will be refunded all fees, except the $50 office fee.*

Horse Information – Please include a photocopy of horse’s registration papers with your entry.

Name of horse AHA Reg. # USEF # USDF # Breed

A HA AA

Sire Dam Sex DOB Sweepstakes? ( ) Y ( ) N

Owner Information – Please include a photocopy of AHA, USEF/EC cards with your entry. Name AHA # Address City State Zip Phone # USEF # USDF # E-mail

Trainer Information – Please include a photocopy of AHA, USEF/EC, cards with your entry. Name AHA # Address City State Zip Phone # USEF # USDF # E-mail

Rider/Handler Information – Please include a photocopy of AHA, USEF/EC cards with your entry. If more spaces are needed for classes, please use two rider/handler spaces for the same horse/rider team. Be sure to fill out the rider/handler information twice if two spaces are used. Rider/Handler Please specify: JR AA Open Classes: AHA # USEF # USDF # Rider/Handler Please specify: JR AA Open Classes: AHA # USEF # USDF # Rider/Handler Please specify: JR AA Open Classes: AHA # USEF # USDF #

Mandatory Fees

Office Fee - $50 (covers both shows) $_____50____

USEF (Drug, USEF) - $23 $_____23____

USEF non-member show pass - $45 $___________

AHA Resolution 9-90 - $15 $_____15____

AHA Results Reporting - $5 $______5____

AHA Recovery Fee - $15 $_____15____

Class Fees

Regional Class Fee - $60 X # of classes______ $___________

Walk/Trot & Equitation - $30 X # of classes______ $___________

Liberty Class - $25 $___________

Exhibition Class - $25 X # of classes______ $___________

TBA Class Fee (Plus class fee)- $40 X # of classes____ $___________

Late Entry Fee – $100 $___________

Patron/Sponsorship – Thank you!

Patron - $300, $500, $700 $_____________

Total: $_____________

Please make checks payable to: Region 6 AHA

Credit card payments will be accepted at the show (swipe only). Credit card payments will incur a 3% processing fee. If you are planning to pay by credit card, please submit a blank check with your entries. Your check will be held at the office and returned to you after your credit card payment has been made.

Regional Championship Entry Form Entries close June 5, 2020. A $100 fee will be charged for entries postmarked or e-mailed after June 5. Please include dressage classes and fees on this form. We cannot accept late entries for dressage. Be sure to include your USDF number if you want your results reported to USDF. USDF membership is not required. Photos of entries and/or texted entries will not be accepted. Please use Stall Form for stalls, stall requests, shavings, hay, and camping.

Send entries to:

Cheri Clark 6723 E Daisy Dr Black Hawk, SD 57718 showringcc@aol.com 406-581-0232

Waivers Please be sure to sign BOTH pages of waivers.

Stalls/Camping

Following the waivers, there is a stall form. Please include all stalls, camping, stabling requests, hay, and shavings on the stall form and submit with your entries.

For office use only

Total $

Paid $

Check #

Balance

Stalling/Camping Form

• Please fill out this form based on who will be paying for the stalls, camping, shavings, and hay.

• Multiple horses can be included on the same form.

• Please include payment for items on this form with your entry check (or submit a blank check if paying

by credit card), and submit this form with your entries.

Billing Name:__________________________________________________________________________

Stabling Requests:______________________________________________________________________

Horse stalls – Full week - $175 x # of stalls_______ $________

Single Night - $30 x # of stalls___ nights___ $________

Tack stalls - $175 x # of stalls_______ $________

Shavings - $8.50 x # of bags________ $________

Hay - $8.00 x # of bales_______ $________

Camping - $40/night x # of nights_______ $________

Sub -Total: $________

For Office Use Only

Added Stalls: Full week - # of stalls_______ $_________

Single night - # of stalls___ nights___ $_________

Added shavings: # of bags_______ $_________

Added hay: # of bales_______ $_________

Added camping: # of nights________ $_________

Sub-total: $_________

Total: $_________