2024 Mystery Futurity & Derby Nomination Form

Select Race:*

Mystery Futurity (For 2-year-old foals of 2023)Mystery Derby (For 3-year-old foals of 2022)

Number of Berths (if you are only entering one race, please enter 0 berths on the race you are not entering into):
Futurity # of berths: *
Derby # of berths: *

Owner:*

Email for submission confirmation:

example@example.com

Phone:*

Please enter a valid phone number.

Address:*

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Trainer Name:

First NameLast Name

Trainer Phone:

Please enter a valid phone number.

Signature:*

(Owner or Authorized Agent)

Date:*

Payment Type:*

Mail a check to OQHRA: PO Box 2907, Edmond, OK 73083Credit Card (3.5% service charge) - Email card info to mckenzie.l@oqhra.com or call the office at 405-216-0440

Race Conditions available upon request and will be provided at the time original nomination is received. Please retain a copy for your records. 12% from payments deducted for A&A. All added money, dates and conditions are subject to OHRC approval.

If you have any questions call OQHRA at 405-216-0440 or oqhraoffice@oqhra.com

For more information visit www.oqhra.com

To receive payment reminders, text "RaceOK" to 405-266-9219