LA PINE RODEO
May 17th Playday Buckle Series Form
TODAY'S DATE:
-
Month
-
Day
Year
Date
Competitor Information
Name:
First Name
Last Name
Phone Number:
Format: (000) 000-0000.
Horse(s) Name(s):
Emergency Contact:
Format: (000) 000-0000.
If Competitor is under the age of 18:
Competitor Age:
Parent/Guardian:
Phone:
AGE DIVISION
AGE DIVISION
Pewee (6 & under)
Junior (7-9)
Intermediate (10-13)
Senior (14-17)
Adult (18-49)
Super Senior (50 & up)
Address: PO Box 674, La Pine, OR 97739 Email: info@lapinerodeo.com Website: www.lapinerodeo.com
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LA PINERODEO
Events ($5 per event)
Events
Barrel Racing
Poles
Keyhole
Birangle
Total:
Please make checks payable to:
La Pine Rodeo Association
PO Box 674, La Pine, OR 97739
I am signing this Entry Form freely and voluntarily on behalf of myself and/or my minor
child(ren).
Participant Name:
Participant Signature:
Parent/Guardian Name:
Parent/Guardian Signature:
Address: PO Box 674, La Pine, OR 97739 Email:
info@lapinerodeo.com
Website:
www.lapinerodeo.com
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Poles
$5.00
$
5.00
Quantity
1
2
3
4
5
6
7
8
9
10
Birangle
$5.00
$
5.00
Quantity
1
2
3
4
5
6
7
8
9
10
Keyhole
$5.00
$
5.00
Quantity
1
2
3
4
5
6
7
8
9
10
Barrel Racing
$5.00
$
5.00
Quantity
1
2
3
4
5
6
7
8
9
10
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
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