Nomination Form GOLD BUCKLE Reining Futurity

Name of Horse*

YEAR OF FUTURITY*

SEX OF HORSE*

StallionMareGelding

Foal Date*

Date

Breed Certificate OR Veterinary Proof of AGE + 4 PHOTOS (off side, near side front & back)*

SIRE*

DAM*

COLOUR/MARKINGS*

REINING AUSTRALIA COMPETITION LICENCE NUMBER - if licensed

BREED ASSOCIATION

BREED REGISTRATION NUMBER

Person Nominating Horse for Gold Buckle program*

First NameLast Name

Contact Phone Number*

E-mail*

Address: (Residential)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Address: (Postal)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please choose your horses futurity category by marking the age of your horse. (all prices incl GST)*

Yearling as @ the 31st December $220Yearling as @ 31st December (part of 5-9 nominations at one time) $165 eachYearling as @ 31st December (part of 10+ nominations at one time) $110 each2 Year Old as @ the 31st December $4403 Year Old as @ the 31st December $6604 Year Old as @ the 31st December $8804 Year Old from 1st January year of the Futurity $1650

Conditions of the Gold Buckle Program

1. All Gold Buckle nominations are non refundable, no exception.

2. You will be sent an invoice with payment details , please wait for your invoice so your payment can be allocated correctly. This will insure your horse will be a Gold Buckle nominee.

3. To gain full entry to your nominated horse's futurity year all payments must be confirmed as fully paid prior to the 31st December cut off, other wise there is a definate price variation as this will fall into the next age bracket and you will be sent an amended invoice for payment.

4. A Gold Buckle Certificate is your proof of nomination, once all documentation including payment has been confirmed, your certificate will be mailed to the nominated postal address above. Please keep this in a safe place.

by ticking the box below you are signing and accepting fully this nomination*

I have read, understood, and accepted the conditions for the Gold Buckle Nomination.

GOLD BUCKLE NOMINATION

PLEASE NOTE ALL PAYMENTS FOR NOMINATIONS ARE DUE & PAYABLE ON OR BEFORE 30th November each year.