Australian Rodeo Queen Quest

Australian Rodeo Queen Quest

Jackpot Barrel Race
Competitor First Name*
Competitor Surname*
Parent or Guardian if Under 18

First NameLast Name
Phone Number*
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState

Post Code
Bank Account details for payment of prizemoney
Bank Account nameFirst Name Last Name
BSBBSB
Account Number Account Number

Jackpot Barrel Race Entry

	# of Horses entered	Horse 1 Name	# Runs Horse 1	Horse 2 Name	# Runs Horse 2	Horse 3 Name	# Runs Horse 3
Open Entry
Junior Entry
Junior Assisted

Cost of Jackpot runs (includes $5 arena levy)

Starkey Farms Non Pro Barrel Race Entry

	# of Horses entered	Horse 1 Name	# Runs Horse 1	Horse 2 Name	# Runs Horse 2	Horse 3 Name	# Runs Horse 3
Open Non Pro Entry
Junior Non Pro Entry

Cost of Starkey Farms Non Pro Barrel Race runs (includes $5 arena levy)
I have read and agree to the conditions listed in the Waiver above (parent or guardian to sign if under 18)*

Clear
Please make payment to:

Account Name: Belle Sternal

BSB: 085 656

Account #: 743 121 022
Should be Empty: