CCPOREntryForm

December 29-31, 2023 & January 1-3, 2024
Westworld of Scottsdale
Scottsdale, Arizona
Name of Horse*
Reg. #*
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 12/15/2023.

REMEMBER - ALL APHA AMATEUR, NOVICE AMATEUR, AMATEUR WALK TROT, NOVICE YOUTH AND YOUTH WALK TROT 11-18 CARDS EXPIRE DECEMBER 31ST, 2023.
Year Foaled*
SEX*
Select Registry*
Owner*
For Leased Horses enter Lesee as Owner
Mailing Address*
City*
State*
Zip Code*
Phone Number
Email Address*
Owner APHA #*
APHA Expiration Date*

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

YesNo
Horse NSBA Certificate #*
Required for NSBA Futurities Only
Owner NSBA #
Required for NSBA entries only
NSBA Expiration Date

MonthDayYear
Upload Owner ID Cards Here
Upload Owner Membership Card(s) Here Cancelof
Is this horse leased?*

YesNo
Upload Lease Here

Cancelof
Will this horse be stalled on show grounds?*

YesNo
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
NAME *
Relationship to Owner*
Are you related to the owner? If not, Relationship is "None"
ADDRESS if not Owner
City
State
Zip
Phone Number
Division: Check all that apply to Exhibitor #1

OpenAmateurNovice AmateurYouthNovice YouthWalk Trot
BIRTH DATE Required if Yth or Ama

MonthDayYear
Upload Exhibitor Cards Here
Upload Exhibitor 1 Membership Card(s) here Cancelof
APHA ID #*
Expiration Date

MonthDayYear
Lifetime
NSBA ID #
NSBA Expiration Date

MonthDayYear
Lifetime
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.*

YesNo
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
NAME
Relationship to Owner*
Are you related to the owner? If not, Relationship is "None"
ADDRESS if not owner
City
State
Zip
Phone Number
Type- Check all that apply to exhibitor #2

OpenAmateurNovice AmateurYouthNovice YouthWalk Trot
BIRTH DATE Required if Yth or Ama

MonthDayYear
Upload Membership Cards Here
Upload Exhibitor 2 Card(s) Here Cancelof
APHA ID #
APHA Expiration Date

MonthDayYear
Lifetime
NSBA ID #
NSBA Expiration Date

MonthDayYear
Lifetime
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.

YesNo
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!
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