AJRA Nomination Online Entry Form

AJRA NOMINATION FORM
CONTESTANT NAME ONE CONTESTANT/ONE RODEO PER ENTRY FORM PLEASE! *

First NameLast Name
Email*
example@example.com
Date of Birth *

MonthDayYear
Date

Phone Number*
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState

Zip Code

My Products

Girls 13-15Girls 13-15

$80.00

Choose Events	Quantity	Price
Barrel Racing		$80.00
Pole Bending		$80.00
Goat Tying		$80.00
Breakaway		$80.00
Team Roping		$80.00

Item subtotal:$0.00

Boys 13-15Boys 13-15

$80.00

Choose Events	Quantity	Price
Tie Down Roping		$80.00
Breakaway		$80.00
Team Roping		$80.00
Bull Riding		$80.00

Item subtotal:$0.00

Girls 16-19Girls 16-19

$80.00

Choose Events	Quantity	Price
Barrel Racing		$80.00
Pole Bending		$80.00
Goat Tying		$80.00
Breakaway		$80.00
Team Roping		$80.00

Item subtotal:$0.00

Boys 16-19Boys 16-19

$80.00

Choose Events	Quantity	Price
Tie Down Roping		$80.00
Steer Wrestling		$80.00
Team Roping		$80.00
Bull Riding		$80.00
Bareback Riding		$80.00
Saddle Bronc Riding		$80.00

Item subtotal:$0.00

Office Fee

$15.00 Quantity

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Team Ropers

I am the HeaderI am the Heeler
Team Ropers Name of Partner First Name Last Name
This is for what region/stateRegion/State What rodeo number Rodeo #
Pay with PayPal

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
Should be Empty: