Memorial Slot Race Entry Form

The Susie McConaghie Slot Race, presented by Adequan, is a fundraising event to benefit the Susie McConaghie Memorial Rodeo Scholarship Fund. This race is open to any age horse or rider. Slots will be sold for $500. Each horse must be nominated prior to their first run at the Fizz Bomb Classic. The nominated horse's fastest time will be used as their Slot Race time

The race will begin when the first Futurity horse runs and end when the last Open horse runs. All checks will be mailed by September 30, from the Susie McConaghie Memorial account and will not be processed through the regular Fizz Bomb and Thar Ranches account or system. This race will be 80% progressive payout . Payout will be in a 2D format with .75 second split. 60% to 1D and 40% to 2D, 3 places paid in each D. $2,500 will be added. Slots will not be limited.

Horse's Registered Name*

Rider's Full Name*

First NameLast Name

Horse Owner's Full Name *

First NameLast Name

Owner's Phone Number

Please enter a valid phone number.

Owner's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Rider's Phone Number*

Please enter a valid phone number.

Rider's Email*

example@example.com

Rider's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Signature of Rider or Parent/Guardian if rider is under the age of 18*

ENTRY FEE - $500

Checks mailed prior to the event, FULL PAYMENT DUE BY August 25,2023 - NO EXCEPTIONS

Checks may be mailed to:

Susie McConaghie Memorial

592 Bishop Rd.
Rozet, Wyoming 87272

Optional On-line payment:

OPEN SLOTOn-line payment includes 5% processing fee

$525.00

Total

$0.00

Credit Card

Award checks will be written to:*

RiderOwner