NBHA OK 05

Aiming High

NBHA Oklahoma Dist. 5

Jackpot Entry Form

 

(Please complete one for per person)

 

Name:_________________________________ DISTR #__________

Address:_________________________________________________

City/State/Zip:____________________________________________

 Pee Wee (8&Under):       _________ x $10.00 = $_________

Open:                            _________ x $25.00 = $_________

ROLL TO YOUTH     YES_______ NO ___________

ROLL TO SENIOR     YES_______ NO ___________

YOUNG HORSE INCENTIVE:  _____X $5.00=     $___________

Senior (50&Over):        _________ x $16.00 = $_________

Youth (18&Under):      _________ x $16.00 = $_________

Young Guns Incentive_________  x $5.00 =  $_________

Facility Fee: (if applicable)     1        x $ 5.00 = ________

TOTAL FEES                                                   $_________

 

INCENTIVE HORSE NAME________________________________