BEAR RIVER RIDERS - OPEN GYMKHANA
ENTRY FORM - Saturday, September 18th, 2010
Registration: 9:00 AM / Start: 10:00 AM

BRR MEMBER? _____YES _____NO

NAME OF HORSE: _______________________________ THIS HORSE FOR POINTS? _____YES _____NO

RIDER NAME: _____________________________________________

CITY:_____________________________ STATE:_________

PHONE:_____________________________ EMERGENCY PHONE: _____________________________


CIRCLE GYMKHANA DIVISION TO ENTER:

Leadline Walk/Trot Novice 12 & Under 13 to 17 18 & Over

CIRCLE GYMKHANA EVENT(S) TO ENTER:

1. Cloverleaf Barrels 2. Big "O" 3. Big "T" 4. Poles

HOW MANY BARREL TIME ONLY'S? (BARREL PRACTICE) ____________


TOTAL GYMKHANA EVENTS ______ @ $5.00 EACH = _____________

TOTAL TIME ONLY'S ______ @ $2.00 EACH (or 3 for $5.00) = _____________

NON-MEMBER FEE (TEMPORARY MEMBERSHIP FEE) @ $5.00 = _____________

TOTAL FEES* $ ______________ PAID: CASH _______ or CHECK # _______


THIS MUST BE SIGNED IN ORDER TO RIDE!
I have read the rules and agree to abide by them or be disqualified. I agree that the Bear River Riders; the officers, board members, volunteers, property owners, horse owners, and sponsors will not be held responsible for any injury or accident to me, my family, my livestock, or my possessions.
I HAVE READ THE ABOVE; AGREE AND UNDERSTAND IT FULLY.

SIGNATURE _____________________________________ DATE_________
(Parent or Guardian if under 18)

*All returned checks are subject to a $25 fee.