ENTRY FORM
Nebraska NBHA 2008 State Championships
June 20, 21 & 22, 2008
Broken Bow, Nebraska
Pre-Entry Close June 6, 2008
If entry form is not postmarked by June 6, 2008 a late entry fee of $40 will
apply.
Late entries will be taken until June 20, 2008 at 6:00 PM.
Name:____________________________
SSN#: ___________________________
Address: __________________________
City: ______________ State: _______ Zip ________
NBHA Member #: __________________
Nebraska District: _________________
Home Phone: ______________________
Work Phone : _____________________
Age: ______________________________
Date of Birth: _____________________
Friday Night Jackpot
June20, -7:00PM
Race 1 & 4 OPEN Sat/Sun
8:30 AM
$5 office fee 80% of $20 to payout - $1,000 added
80% of $60 to payout
Horse: ___________________________ $25
Horse: _____________________________$60
Horse: ___________________________ $25
Horse: _____________________________$60
Horse: ___________________________ $25
Horse: _____________________________$60
Race 2 & 5
YOUTH Sat/Sun
Race 3 & 6
SENIOR Sat/Sun
80% of $30 to payout
80% of $40 to payout
Horse: ___________________________$30
Horse:_____________________________$40
Horse: ___________________________$30
Horse: ____________________________ $40
Horse: ___________________________$30
Horse: ____________________________ $40
Stalls - $20/1st night/$15 2nd nightl
Electrical Hook-up $15 per night
______ (# of stalls) 1st
night includes
________ (# of nights)
______ (# of nights) 1 bag
shavings
Wood Shavings - $8 per bag
1 bag required per stall
_____# of family members attending free
______ ( # of bags)
barbeque Saturday night
I submitting my entry, I hereby release the NBHA,
Entry Fees Total
$________
Show organizers and all officials, employees,
Processing Fee
$__20.00__
Directors or agents of same, from any claims for
Stalls
... $________
Loss or damages, which may occur to my horse
Electrical Hook-up
$ ________
or my property at this show. Return check fee is
Wood Shavings
...$_________
$35.00.
Signature: _________________________________
Late Fee ($40.00)
... $
________
(Must be signed by every participant, Parent/Guardian for minors)
TOTAL FEES $_______
Mail payment to: Susan Swanson
621 Cedar St.
Friend Ne.
68359