NRCHAA 2026 Futurity Derby Nomination Form

National Reined Cow Horse Association Australia Incorporated

Email: info@nrchaaustralia.com
2026 FUTURITY & DERBY

11-15 MARCH 2026

Enquiries to:

Michael Rapley 0448 007 497 Tim O'Brien 0428 488 273

NOMINATION FORM

ONE FORM PER HORSE

COMPETITOR/OWNER DETAILS
Competitor Name

First NameLast Name
Owner Name
As it appears on registration papers
Phone Number
Please enter a valid phone number.Format: 0000 000 000.
Email
example@example.com
Are you a current NRCHAA Member?
Member No:
Type NA if your have not received a number
BANK DETAILS

(PRIZE MONEY OR REFUNDS)
Account Name:
BSB:
Account No:

NOMINATION DETAILS

ENTER HORSES REGISTERED NAME AND SELECT EVENT
Horse Name
PLEASE BE SURE TO ADD YOUR CAMPING/YARDS
prevnext( X )
FUTURITY
Class 1:

$500.00 AUD



FUTURITY LIMITED
Class 2: MUST SELECT CLASS 1 & CLASS 2 Futurity Limited is a Class within a class (Class 1: $500 + Class 2: $100)

$100.00 AUD



DERBY
Class 1: Derby

$500.00 AUD



DERBY LIMITED
Class 2: MUST SELECT CLASS 1 & CLASS 2 Derby Limited is a Class within a class (Class 1: $500 + Class 2: $100)

$100.00 AUD



NON PRO FUTURITY
$480.00 AUD



NON PRO DERBY
$480.00 AUD



CAMPING
PER FLOAT PER NIGHT

$10.00 AUD



Total

$0.00 AUD

PROOF OF AGE

Please upload Horse Registration Certificate
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PAYMENT INFORMATION
Please make payment to:

NRCHAA

BSB: 082-842 Acc No: 84 348 1682
Bank Reference:
Check Box to acknowledge scratchings or changes
Payment Receipt

Please upload a copy of your payment receipt
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DECLARATION
Check Box to acknowledge disclaimer
Should be Empty: