RECEIPT FORM
(To be sent with check or money order)
NAME: _______________________________________REGION 10 # ____
ADDRESS: _____________________________________________________________
_____________________________________________________________
PHONE NUMBER: (__________) _______ - ______________________
E-MAIL ADDRESS:________________________________@___________________
I am entering in OF Plastic_______ OF China/Resin _______ CM Glazed______
AR______ CM _______ Foal Classes _______ Novice_______
Lunch fee $5 per person X_______ person/people
Proxy fee $3 per horse (up to 10) or $40 for full entry _______
Entry fee_______
Proxy fee_______
lunch fee_______
total fees_______
Would you like email or mail confirmation of this receipt? (circle one. Please include SASE for mail confirmation)