FEABRA Show #4, April 17, 2022 Entry Form -

1

Rider's Name

First Name

Last Name

2

Emailrequired please

example@example.com

3

Address - OptionalThis is for office if you leave before payout so winnings can be mailed.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

4

Phone Numberoptional

Area Code

Phone Number

5

Entry fees & classes

Exh 11:00 am - 12:30 noon SHARP $4 EACH - One at a time, no riding around arena

Church 12:35- 1:05 pm

Pee Wee - 1:20pm

Open 4D - follows - but not before 1:30 pm - (open to all) - EF $30 members, $35 nonmembers - Added money TBA

Youth 2D - follows - 17 & younger - $25 for all - 1 sec split - must have 5 entries or more to be 2D split; otherwise, 1st place wins all - pts are still given 2D

Senior 2D - sidepot only - 40 + years - 1 second split - $25 for all must have 5 entries or more for 2D split; otherwise, 1st place wins. 2D points still given

World Athlete Entrepreneur Sidepot - open to all but if you want to run and earn points for 2023 final show - you must be a member. Membership form is on the World Athlete Entrepreneur link at floridaequineathlete.com, or can be purchased in the ofice - $30 EF - $5 goes toward added money for the WAE class.

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Youth Rider's Birth Date:Must be 17 or under

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Pee Wee Rider's Birth Date:Must be 9 or younger

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How many Exhibitions

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Horse's Name

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Classesclick on each class wanted

Pee Wee (9 & younger) - Beginners only - $5 each

Open ($30 members, $35 nonmembers) - Open to all

Youth - 17 & under - $25 for all - check one of the two lines underneath for rolling over or running.

Youth roll over time from open to youth

Youth - physically run the class

Senior - 40 + yrs - $25 for all

World Athlete Entrepreneur sidepot - $30 - ($5 goes toward added for this class) - Anyone can enter but, if you want to run for points to go to 2023 Finals, you must be a member. All information on the World Athlete Entrepreneur link at floridaequineathlete.com. This is a new Florida Equine Athlete barrel racing series. It is a sidepot series where you run at participating host organizations and there will be a "Finals" show in 2023.

11

For the Open, please give me 3 numbers you would like and I will try to give your the earliest number possible.

Please enter a number

12

Horse's Name

13

Classesclick on each class wanted

Pee Wee (9 & younger) - Beginners only - $5 each

Open ($30 members, $35 nonmembers) - Open to all

Youth - 17 & under - $25 for all - check one of the two lines underneath for rolling over or running.

Youth roll over time from open to youth

Youth - physically run the class

Senior - 40 + yrs - $25 for all

World Athlete Entrepreneur sidepot - $30 - ($5 goes toward added for this class) - Anyone can enter but, if you want to run for points to go to 2023 Finals, you must be a member. All information on the World Athlete Entrepreneur link at floridaequineathlete.com. This is a new Florida Equine Athlete barrel racing series. It is a sidepot series where you run at participating host organizations and there will be a "Finals" show in 2023.

14

For the Open, please give me 3 numbers you would like and I will try to give your the earliest number possible.

Please enter a number

15

Horse's Name

16

Classesclick on each class wanted

Pee Wee (9 & younger) - Beginners only - $5 each

Open ($30 members, $35 nonmembers) - Open to all

Youth - 17 & under - $25 for all - check one of the two lines underneath for rolling over or running.

Youth roll over time from open to youth

Youth - physically run the class

Senior - 40 + yrs - $25 for all

World Athlete Entrepreneur sidepot - $30 - ($5 goes toward added for this class) - Anyone can enter but, if you want to run for points to go to 2023 Finals, you must be a member. All information on the World Athlete Entrepreneur link at floridaequineathlete.com. This is a new Florida Equine Athlete barrel racing series. It is a sidepot series where you run at participating host organizations and there will be a "Finals" show in 2023.

17

For the Open, please give me 3 numbers you would like and I will try to give your the earliest number possible.

Please enter a number

18

Payment TypeYou can either prepay entries or pay at show. An email will be sent to you with your total and the options of how to pay. A small fee may apply depending on how prepay.

Would like to PrePay entries

Pay at show

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In accepting this entry, the applicant hereby releases and discharges the Florida Equine Athlete, all officers, personnel, representatives, employees, agents, Melissa Greer Ph.D., host arenas, arena owners, and family members from liability, loss, claims, damages, and/or expenses for injuries or death to person, animal, property, family member(s), friends, or anyone affiliated with applicant, reputations, or financial conditions as a results of, or in any way, relating to applicant’s participation or nonparticipation in FEABRA sanctioned event whether caused by negligence, arena conditions, and/or by the conduct of the Florida Equine Athlete or arena hosts, owners, officers, etc.PLEASE BE SURE TO MARK THE BOX BELOW.

I have read, understood, and accepted the above waiver statement for entry and participataion of this show.

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Signature For Youth entries, this form MUST be signed by parent or guardian; I will need a parent or guardian to verify this permission at the day of the show.

Clear

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Date signed

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Once you submit your application, I will send you a confirmation of entry. If you do NOT receive confirmation, please shoot an email to floridaequineathlete@gmail.com to make sure it was received.

See you April 17th and please drive safely. God Bless

Oh, and if you pre enter AND prepay, you do not have to come up to the announcer's stand, just shoot me a text stating you are here at 863-398-6802. Be sure you state your name as I do not have everyone saved in my contact's list on my phone.

Thank you for coming! :)