Fall Works - Ranch Horse Extravaganza 2024

Fall Works - Ranch Horse Extravaganza

September 6, 7 & 8, 2024, Jackpot Ranch, Camp Verde, AZ
ENTRY DEADLINE is MONDAY SEPTEMBER 2, 2024!

ALL ENTRIES RECEIVED AFTER 9/2 WILL BE ACCESSED A $25 LATE FEE!
Please complete one form per each horse/rider combo.

If you experience any difficulty with this form, please contact azvrha.info@gmail.com.

Rider Information
Rider Name*

First NameLast Name
AzVRHA / WSVRHA Member #
If not known, leave blank
AQHA Member #
If you need a AzVRHA / WSVRHA membership, please fill out the online form. MEMBERSHIP FORM
Phone Number*

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you an Amateur Rider?*

YesNo
Date of Birth (if a youth)

MonthDayYear
Date
*If you are an Amateur Rider and a new member please fill out the online Division Eligibility form.
Emergency Contact Information
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number

Owner Information
*Check here if rider and owner are the same. (You don't need to fill out owner info if the same.)
Owners Name

First NameLast Name
WSVHRA Member #
AQHA Member #
If you need a AzVRHA / WSVRHA membership, please fill out the online form. MEMBERSHIP FORM
Email
example@example.com
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Membership
AzVRHA / WSVRHA Membership Due
Please include the total amount due from your online membership form. (if applicable)
If you need a AzVRHA / WSVRHA membership, please fill out the online form. MEMBERSHIP FORM

*Only required if you haven't already paid your membership. If you purchase a membership at the Fall Works show it will also be good for the 2025 season.

Fee Calculations (Entries, Shavings, Stalls, RV, Haul-In)
Friday Clinic - Fee Total
SATURDAY ENTRY TOTALS
Saturday All Around Fee
Saturday A La Carte Fee
Saturday RHAA Fee
Saturday RHC Fee
Ranch Rail Jackpot Entry
SUNDAY ENTRY TOTALS
Sunday All Around Fee
Sunday A La Carte Fee
ADDITIONAL FEES
Additional Entry Options

I wish to compete for AzVRHA Jr Horse Awards $20I wish to compete for AzVRHA Select Rider Awards $20
AzQHA Award Fee - $2/class (AQHA classes only)
Enter the total amount
AQHA Office / Drug Fee - $25/horse
Enter the total amount
Office Fee @ $60 per horse (WSVRHA $40 / AzVRHA $20)

ALL ENTRIES RECEIVED AFTER 9/2 WILL BE ACCESSED A $25 LATE FEE!
DATES / SHAVINGS / STALLS / RV / HAUL IN
Arrival Date

MonthDayYear
Date
Departure Date

MonthDayYear
Date
Shavings
# of bags ($13 per bag)
Total Due for Shavings
Stalls
# of stalls
# of Stall Nights
# of nights ($35/night)
Total Due for Stalls
RV Hookup
# of spots
# of RV Nights
# of nights ($35/night)
Total Due for RV Hookup
RV Dry Camp / Haul-In
# of days
# of RV Nights / Haul In
# of nights /haul in ($15/day)
Total Due for Dry Camp / Haul-In
TOTAL PREMIUM DUE:
ALL ENTRIES RECEIVED AFTER 9/2 WILL BE ACCESSED A $25 LATE FEE!

You must check-in at the show office before participating. Payment is due upon check-in at the event. Payment Options: Checks made payable to AzVRHA or Cash.

Cancellations & Payment Information
Cancellation Policy:

If you cancel 5 days before the event, there will be no charge.

If you cancel under 5 days before the event, you will be responsible for cattle and office fees.
Payment Information:

Payment Options: Credit Card (3.5% processing fee + $.30 per transaction fee), Checks made payable to AzVRHA or Cash.

The form now requires credit card details to complete the process. Rest assured, we will not charge your card unless you opt to use it for payment at event check-in, or in case of a last-minute cancellation or no-show.

You must check-in at the show office before participating. Payment is due upon check-in at the event.

Waiver
Release: Under Arizona Law, an equine professional is not liable for injury to or death of a participant in equine activites resulting for the inherent risks of equine activities, pursuant to Arizona Revised Statutes, Title 12, Chapter 5, Article 3. I/We hereby request to enter the event indicated and agree to abide by the bylaws, standing rules, judging and rules of the respective organizations involved with this event. I/We hereby release WSVRHA, AzVRHA, AzQHA and any other involved organizations and its members, officers, and employees from any loss to myself, employees, agents, horses and/or equipment while attending and/or participating in this event. The provisions contained herein are hereby made a part of this entry agreement. In addition, the general understanding of any "publication, video, and internet consent and release agreement" is incorporated in this release including: no monetary considerations, photo, video or verbal statments may be used now and in the subsequent years as the program deems fit; is binding upon heirs and/or future legal representatives.
Signature of Rider*

Powered by Jotform SignClear
Date*

MonthDayYear
Date
Signature of parent/guardian (if rider is under 18)

Powered by Jotform SignClear
Date

MonthDayYear
Date
CONTACT INFO:

For Information Contact Leigh at 623-910-5046 or azvrha.info@gmail.com
Should be Empty:

Fall Works - Ranch Horse Extravaganza