2026 5-State Youth Breakaway Entry

2026 5-State Youth Breakaway Entry

$250 added - 100% payback of fees and added money
Registered Name of Horse - one form per horse*
Sire*
Year Born*
Contestant*

First NameLast Name
Owner*

First NameLast Name
Contact Email*
example@example.com
Address of where checks to be sent to*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
OwnerRider
$75 Youth Breakaway - due June 17th
Front Of Registration Papers*

Cancelof
Back Of Registration Papers (if applicable)

Cancelof
YOUTH BAW RULES - go to the entry forms at 5statebreedersfuturity.com

By making payment and submitting this form I am entering the above horse in the 5-State Breeders Futurity. I (we) agree that all 5-State Futurity rules are final. I (we) release the 5-State Futurity, LI Productions LLC, the Central States Fairgrounds, and futurity co-sponsors from any claims to myself, rider, employee, horse, and equipment. I understand LI Productions, LLC reserves the right to refuse entry.

My Products

Youth BAW

13 and under (January 1)

$75.00 Quantity

Subtotal

$0.00

Tax

$0.00

Total

$0.00