5-State Youth Pole Bending Form
$35 entry fee (includes 1 exhibition) - 100% payback of the $30- age to 13 (Jan 1)-DUE JULY 1 if just entering youth - DUE JUNE 17 if a Maturity carry over (or will have late fees)
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Registered Name Horse 1
*
Registration Papers Horse 1
*
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Is this a carry over to the Maturity
Registered Name Horse 2
Registration papers horse 2
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Is this a carry over to the Maturity
Registered Name Horse 3
Registration papers horse 3
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of
Is this a carry over to the Maturity
If you already entered the Maturity and want to do the youth option now, write us a note so we can fix your entry.
My Products
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Number of horses entered
$35 per horse plus credit card fee
$37.00
$
37.00
Quantity
1
2
3
4
5
6
7
8
9
10
Carry Over to Maturity
credit card fee included
$68.00
$
68.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card
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