FEABRA Show #4 - September 29, 2024 Entry Form -

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Rider's Name

First Name

Last Name

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Emailrequired please

example@example.com

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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

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Phone Numberoptional

Area Code

Phone Number

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Entry fees & classes:

PLEASE NOTE: Everyone must sign a NEW Accident Release Waiver for 2024. If you signed one at previous shows in 2024, you do not have to sign another one.

GATES OPEN AT 10 AM!!

Exh 11:00 am - 12:30 pm SHARP $4 EACH - One at a time, no riding around arena, keep forward motion

Church 12:35 - 1:05 pm

Pee Wees must be signed in by 1:05 pm

Pee Wees 1:20 pm $5 EF - Ribbons only are given (10 & younger - beginners only) Cannot enter another class

Open 4D - follows but not before 1:30 pm - EF $30 EF + $5 to go toward added = $35 total entry fee for all

Youth 2D follows (may roll over from open or run) - 17 & younger - $25 for all - 1 sec split

Sidepots:

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

WAE 4D - $25 EF + $5 goes toward added money = $30 EF

I will get back to you with an entry number and how the entry fee total owed. If you do not hear back from me, that means I did not get the entry. Please follow up with me either by PM on FB or email floridaequineathlete@gmail.com

if prepaying entry Fees, this must be paid by 11am, Friday, September 27, 2024

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Youth Rider's Birth Date:Must be 17 or under

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How many Exhibitions

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1st Horse's Name

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Classesclick on each class wanted

Pee Wee (10 & younger) - Beginners only - $5

Open ($30 ef + 5 toward added = $35 total, for all) - Open to all

Youth - 17 & under - $25 for all - 2D payout with one second split

If entering Youth, check here if rolling over time from the open

If entering Youth, check here if physically running

Seniors - 40+ years - $25 for all - roll over only - 2D payout with one second split - 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 of the EF goes toward added. Roll over only

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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

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2nd Horse's Name

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Classesclick on each class wanted

Pee Wee (10 yrs & younger) - Beginners only - $5

Open ($30 ef + $5 toward added = $35 total) Open to all

Youth - 17 & under - $25 for all - 2D payout - 1 second split

If running Youth, check here if rolling over time from the open

If running Youth, check here if physically running

Seniors - 40+ years - $25 for all - roll over only - 2D payout with one second split 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. roll over only

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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

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3rd Horse's Name

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Classesclick on each class wanted

Pee Wee (10 yrs & younger) - Beginners only - $5

Open ($30 EF + $5 to go towards added = $35 total ) - Open to all

Youth - 17 & under - $25 for all - 2D payout - 1 second split

If entering Youth, click here if rolling over time from the open

If entering Youth, click here if physically running

Seniors - 40+ years - $25 for all - roll over only - 2D payout with one second split - 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. roll over only

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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

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Type a question

I am a FEABRA member

FEABRA nonmember

Would like to be a 2024 FEABRA member - Show #4 is the last show you can become a member for this series

WAE 2024 member

WAE nonmember

Would like to be a 2024 World Athlete Entrepreneur member

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If prepaying entries, how did you want to pay? Prepaying entries stopped at 11 am today Friday, Sept 27th. Please bring cash to the show.

Paypal - drmgreer@gmail.com (friends and family)

Venmo @Melissa-GreerPhD-1

Cash App - $FLEquineAthlete

Credit Card - there is a small fee

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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, 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.

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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

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Date signed