Autumn Leaf Model Horse Show Entry Form NAME: _________________________________________________ ADDRESS:________________________________________________________ CITY/STATE/ZIP:___________________________________________________ PHONE: __ (_____) _______________________ EMAIL: _____________________________________________________________ INITIALS TO BE USED IN THE RESULTS: ______________ Best Way To Contact You? ___________________________________________________ _________ Full 8’ Table Entry Fee With Lunch ($60) _________ Full 8’ Table Entry Fee No Lunch ($50) _________ Half Table With Lunch ($35) _________ Half Table No Lunch ($25) _________ Child Entry with lunch ($25) No lunch ($20) -- 14 & Under (Half-Table)(Not NAN Qualified) _________ Novice Entry with lunch ($25) No lunch ($20) (Half-Table)(Not NAN Qualified) _________ Extra Lunch $10 _________ Proxy horses $2.00 per horse (A maximum of 25 horses may be proxied) Extra Chair if so How Many: _______(Each Entry will get one Chair any other please list) Class Sponsorship (optional, check one): Class ($2) _____ Championship ($4) _____ Overall ($6)_____ > Entries can be mailed (and check made out) to: Rebecca Lamon 7946 Smith Creek Rd Lanesville, IN 47136 Paypal: goodday422@yahoo.com If you pay by PayPal, PLEASE send it as a personal payment (Family & Friends), so that fees are not taken out. If fees are taken out, you will be held responsible for them. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ *Release of Liability: I am entering this show voluntarily. By entering Autumn Leaf Model Horse Show, I understand that I release the show holder, the show hall, and any show officials from liability for any losses, stolen or damaged property, or personal injury that occurs in conjunction with this event. *CODE OF CONDUCT: By entering Autumn Leaf Model Horse Show, I understand that I am agreeing to adhere to the code of conduct. I agree to follow all show rules, follow instructions of the show holder and the judges, and to hold responsibility for any and all of my actions, and the actions of any guests I choose to bring with me. I have read the show packet and agree to all rules within. Signature of Shower: ______________________________________________ Date: _________________________ Please Seat Me Next To:_________________________________________ If entrant is under 18, parent or legal guardian must sign here:_______________________________________