LA PINERODEO
July 18th 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:
Format: (000) 000-0000.
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
Figure 8
Birangle
Total:
My Products
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Barrel Racing
$5.00
$
5.00
Quantity
1
2
3
4
5
6
7
8
9
10
Poles
$5.00
$
5.00
Quantity
1
2
3
4
5
6
7
8
9
10
Figure 8
$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
Debit or Credit Card
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
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2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
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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