CCPOREntryForm

December 29-31, 2022 & January 1-3, 2023
Westworld of Scottsdale
Scottsdale, Arizona

Please Note: Futurities must be entered on the Futurity Entry Form and must be pre-paid. Using this form will NOT enter your horse in any Copper Country or West Coast Breeders Futurity.

Post Entry Fee - $25 per horse in effect after 12/15/2022.

Name of Horse *

Year Foaled *

SEX *

Select Registry *

Reg. # *

Owner *

For Leased Horses enter Lesee as Owner

Mailing Address *

City *

State *

Zip Code *

Phone *

Email Address *

Owner APHA # *

APHA Expiration Date *

Month Day Year

Will this horse be entered in NSBA classes/futurities? *

Yes No

Horse NSBA Certificate # *

Required for NSBA Futurities Only

Owner NSBA #

Required for NSBA entries only

NSBA Expiration Date

Month Day Year

Upload Owner ID Cards Here

Upload Owner Membership Card(s) Here

Is this horse leased? *

Yes No

Upload Lease Here

Will this horse be stalled on show grounds? *

Yes No

Trainer: *

I am aware of and understand that there are inherent risks associated with equine activities. I do hereby consent and agree that the Arizona Paint Horse Club, American Paint Horse Association, National Snaffle Bit Association and/or any cooperative person or group is not liable for an injury to or death of a participant due to the inherent risks associated with these activities and shall not be held responsible for loss, damage and/or liability sustained or suffered while on the show grounds or during participation in this horse show.

OWNER/AGENT *

PARENT/GUARDIAN OF MINOR

Exhibitor #1

Type- Check all that apply to Exhibitor #1

Open Amateur Novice Amateur Youth Novice Youth Walk Trot

NAME *

Relationship to Owner *

Are you related to the owner? If not, Relationship is "None"

BIRTH DATE Required if Yth or Ama

Month Day Year

Upload Exhibitor Cards Here

Upload Exhibitor 1 Membership Card(s) here

APHA ID # *

Expiration Date

Month Day Year

Lifetime

NSBA ID #

NSBA Expiration Date

Month Day Year

Lifetime

ADDRESS if not Owner

City

State

Zip

Are classes the same for Exhibitor #1, both shows? If classes are the same click "Yes" and enter class numbers one time in the Dec 29-31 Box. If classes are not the same, click "No" and enter the class numbers for each show in the appropriate box. *

Yes No

Dec 29-31 Classes Enter Class # (101,102,103) followed by the "Enter" key for each class.

January 1-3 Classes Enter Class # (101,102,103) followed by the "Enter" key for each class.

If your entry is complete, click Submit Form. If not, continue to next exhibitor.

Exhibitor #2

Type- Check all that apply to exhibitor #2

Open Amateur Novice Amateur Youth Novice Youth Walk Trot

NAME

Relationship to Owner *

Are you related to the owner? If not, Relationship is "None"

BIRTH DATE Required if Yth or Ama

Month Day Year

Upload Membership Cards Here

Upload Exhibitor 2 Card(s) Here

APHA ID #

APHA Expiration Date

Month Day Year

Lifetime

NSBA ID #

NSBA Expiration Date

Month Day Year

Lifetime

ADDRESS if not owner

City

State

Zip

Are classes the same for Exhibitor #2, both shows? If classes are the same click "Yes" and enter class numbers one time in the Dec 29-31 Box. If classes are not the same, click "No" and enter the class numbers for each show in the appropriate box.

Yes No

Dec 29-31 Classes Enter class # (101, 102, 103) followed by the "enter" key for each class

January 1-3 Classes Enter Class # (101,102,103) followed by the "Enter" key for each class.

Message to Show Secretary (optional)

If your entry is complete click Submit Form. If more than 2 exhibitors, use another entry.
Thank you for using online entry! See you at the show!