MGTJ Buckle Series Show #5 - October 8, 2023 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 pm SHARP $4 EACH - One at a time, no riding around arena, keep forward motion

Church service 12:35 - 1:05 pm - Please note: David Gillett, from Cowboys for Christ, will be coming around 11 am and will provide baptizing services throughout the day besides church service, if anyone is interested in getting baptized.

There is NO pee wee

1:30 pm - Open 4D (open to all) - EF $30 +5 to go toward added money = $35 EF Total FOR ALL

Sidepots:

Youth 2D - 17 & younger - $25 for all - 1 sec split - - roll over only

Senior 2D - 40 + years - $25 for all - 1 sec split - roll over only

WAE 4D - $30 EF + $5 goes toward added money - All information on the World Athlete Entrepreneur link at floridaequineathlete.com. You do not have to be a WAE member to run, just if you want points to go to the finals. Roll over only

If prepaying entries, this must be done by 1 pm Friday, October 6, 2023.

All information is on the Melissa's Good Timin Jackpot link at floridaequineathlete.com - This includes Rules, Policies, and Payouts are on these rules and policies.

Buckles awarded to Open class division champions at the end of the series. For tie breakers, I look at show count and volunteer hours.

Accident Waiver and Release Liability Forms are to be signed again for the 2023 year, if you have not done so.

Everyone is welcome to run. Do not have to be a buckle series member.

Also, for the WAE Sidepot, you do not have to be a member to run this sidepot.

Entries paid at the show are CASH ONLY and please bring small bills. 10s, 5s, 1s are always a good thing!!

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 - $30 EF + $5 that goes toward added money = $35 total entry fee

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

Seniors - 40+ years - $25 for all -- Roll over only

WAE 4D - do not have to be a member to run; but, if want points to go to the WAE finals, you must be a member - $25 EF + $5 toward added = $30 Total EF Roll over only. 2023 membership is due

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 - $30 EF + $5 toward added = $35 total EF

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

Seniors - 40+ years - $25 for all - roll over only - Roll over Only

WAE 4D - do not have to be a member to run; but, if want points to go to the WAE finals, you must be a member - $25 EF + $5 going toward added = $30 Total 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 - $30 EF + $5 to go toward added = $35 Total EF

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

Seniors - 40+ years - $25 for all - roll over only - Roll over Only

WAE 4D - do not have to be a member to run; but, if want points to go to the WAE finals, you must be a member - $25 + $5 toward added = $30 Total Entry. 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

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

18

If pre paying how would you like to pay for your entries

Paypal

Venmo

Cash App

FB Messenge

19

I am a MGTJ 2nd quarter buckle series member

I am NOT a MGTJ 2ND quarter buckle series member

If running the WAE sidepot, I am a WAE member

If running the WAE sidepot, I would like to be a WAE member

if running the WAE sidepot, I am not a WAE member (do not have to be a WAE member to run sidepot

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 (Lise Blanton), 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.

21

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, and/or sign at show.

Clear

22

Date signed

23

Thank you for coming, See you on Sunday the 24th and drive safe.

If you complete this online entry form and prepay entries, you will need to just text me at 863-398-6802 and let me know you are here. You can also PM me on FB (as long as my connection is working). When texting, please be sure to state your name as I do not have everyone logged into my phone contacts.