WSVRHA 2024 Championships

WSVRHA 2024 Championships

October 17-19, 2024
The Winnemucca Event Center Complex

1000 Fairgrounds Rd, Winnemucca, Nevada 89445
Entry Deadline is Tuesday October 1, 2024

Please complete one form per each Horse/Rider Combination

If you experience any difficulty with this form, please contact amyfinley12@yahoo.com

For Stall and RV Reservations please go to www.openstalls.com

(It is easiest if one person from each trainer barn fills out form for everyone)

Host Hotel is Winnemucca Inn - Group Code WSVRHA

Rider Information
Rider Name*

First NameLast Name
WSVRHA Member #
If not known, leave blank
AQHA Member #
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
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 #
Email
example@example.com
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Horse Information
Registered Name of Horse*
Sex*

MareGeldingStallion
Year Foaled*
Breed*
AQHA Registration #
Must have copy of AQHA papers for AQHA.
WSVRHA Horse ID #
If not known, leave blank.

Fee Calculations
SHOW #1 ENTRY TOTALS
Show #1 All Around Fee
Show #1 Individual Fee
RHC Fee
SHOW #2 ENTRY TOTALS
Show #2 All Around Fee
Show # 2 Individual Fee
ADDITIONAL FEES
Additional Entry Options

I wish to compete for WSVRHA Jr Horse Awards $20I wish to compete for WSVRHA Select Rider Awards $20
AQHA Administration Fee - $25/horse
Enter the total amount
Office Fee @ $40 per horse
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:
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 WSVRHA or Cash.

Cancellations & Payment Information
Cancellation Policy:

If you cancel by October 10th , there will be no charge.

If you cancel after October 10th, you will be responsible for cattle and office fees.
Payment Information:

Payment Options: Checks made payable to WSVRHA or Cash.

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

Waiver
ACKNOWLEDGEMENT OF RISK: The undersigned acknowledges that the participation in horse events either as a contestant, an employee or a volunteer exposes the participant to a substantial and serious risk of property damage, personal injury, or death. The undersigned expressly acknowledges that his/her participation in the event will involve such a hazard. RELEASE OF SPONSORS: The undersigned hereby releases all sponsors from liability and any and all property damage, personal injuries or other claims arising from the undersigned’s participation in the event, including those known and unknown, unforeseen, and future contingent. COVENANT NOT TO SUE: The undersigned covenants that the undersigned shall not now or anytime in the future, directly or indirectly, commence or prosecute any action, suit, or other proceeding against the Western States Versatility Ranch Horse Association, its affiliates, Officers, Board of Directors, Volunteers, or any other sponsors. ASSURANCES: The undersigned has full power, authority, capacity and right without limitation to execute, deliver and perform this release. BINDING EFFECT: The release shall be binding upon the undersigned and the undersigned’s spouse, legal representatives, heirs, successors, and assigns.
Signature of Rider*

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Date*

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

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Date

MonthDayYear
Date
CONTACT INFO:

For Information Contact Amy at 940-445-5861 or asfinley12@yahoo.com
Should be Empty:

WSVRHA 2024 Championships

The Winnemucca Event Center Complex

Emergency Contact Information

Open Division

Amateur Divisions

Youth Divisions

Individual Entries

RHC Entry

Open Division

Amateur Divisions

Youth Divisions

Individual Entries