MGTJ Buckle Series Show #5, June 26, 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

There will be NO Pee Wee class due to the summer heat

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

Open 4D - 1:30 pm - (open to all) - EF $35 FOR ALL - $5 goes toward added

Youth 2D - sidepot (roll over) only - 17 & younger - $25 for all - 1 sec split - must have more than 5 entries to be 2D payout; otherwise, 1st place wins all -

Senior 2D - sidepot (roll over) only - 40 + years - 1 second split - $25 for all must have more than 5 entries for 2D payout; otherwise, 1st place wins.

World Athlete Entrepreneur Sidepot (roll over only) - 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 - $30 EF - $5 goes toward added money for the WAE class.

Karen Sidepot - Our FEA Family Member, Karen Culp passed away Sunday, June 12th from Cancer. In lieu of flowers, she told me she wanted donations to the feed store and hay supplier to keep her animals fed. Now, I have found that the life insurance policy had a 2 year requirement and is not valid so there is no valid life insurance policy. I am holding this sidepot to help with the animals and anything else the family may need.
$25 EF with 70% payback. All monies from this particular class will go towards the animals feed and hay bill.

If prepaying entries, this must be done by 1 pm Friday, June 24, 2022.

6

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

7

How many Exhibitions

8

Horse's Name

9

Classesclick on each class wanted

Open ($35 for all) - Open to all

Youth - 17 & under - $25 for all - roll over only

Senior - 40 + yrs - $25 for all roll over only

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.

Karen Benefit Sidepot - $25 EF - roll over only

10

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

11

Horse's Name

12

Classesclick on each class wanted

Open ($35 For all ) - Open to all

Youth - 17 & under - $25 for all - roll over only

Senior - 40 + yrs - $25 for all roll over only

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.

Karen Benefit Sidepot - $25 EF - roll over only

13

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

14

Horse's Name

15

Classesclick on each class wanted

Open ($35 for all) - Open to all

Youth - 17 & under - $25 for all - roll over only

Senior - 40 + yrs - $25 for all - roll over only

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.

Karen Benefit Sidepot - $25 EF - roll over only

16

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

17

MGTJ Buckle Series Member

Member

Nonmember

18

World Athlete Entrepreneur Sidepot SeriesRun for the 2023 finals - Do not have to be a member to run the class but, if you want to earn points you must be a member.

Member

NonMember

19

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

20

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 or Melissa's Good Timin Jackpot sanctioned event whether caused by negligence, arena conditions, and/or by the conduct of the Florida Equine Athlete, Melissa Greer, PhD 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

22

Date signed

23

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.

If you are prepaying entries, this must be done by 1 pm Friday, June 24, 2022.

See you June 26, 2022 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! :)