AAY 2024 Entry 2024 ALTERNATE ENTRY All-American Youth Entry Form 2024 "*" indicates required fields Unique IDDate of Birth* MM slash DD slash YYYY Entry Date MM slash DD slash YYYY Division Youth (12 and under as of Jan 1, 2024) Teen (13 and older as of Jan 1, 2024) Name First Last Email* PhoneSSN* Credit Card Billing Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Rider Mailing Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Entry OptionsEntry Horse 1 Price: Entry Horse 2 Price: Entry Horse 3 Price: Entry Horse 4 Price: How many horses will you be entering?* One Two Three Four None (stall reservation only) PLEASE NOTE THAT ALL SIDEPOTS ARE OPTIONAL AND NOT REQUIRED TO ENTER IN ORDER TO RACE.Horse #1 Name AAY Fees Horse 1 $200 Entry Fee $50 Sidepot $100 Pony Race $50 Average Side Pot Horse #2 Name AAY Fees Horse 2 $200 Entry Fee $50 Sidepot $100 Pony Race $50 Average Side Pot Horse #3 Name AAY Fees Horse 3 $200 Entry Fee $50 Sidepot $100 Pony Race $50 Average Side Pot Horse #4 Name AAY Fees Horse 4 $200 Entry Fee $50 Sidepot $100 Pony Race $50 Average Side Pot NOTE: You must enter the OPEN RACE in order to enter a SIDE POT. Please correct your entry if you have entered a SIDE POT without entering the corresponding OPEN RACE.STALLS INCLUDES 2 BAGS SHAVINGSStalls no longer available thru entry form. QuantitySorry no more stalls are available at this time.Late Fees Price: Online Entry Fee plus AAY Text & Alerts Price: Don't miss important text alerts from the LanBar Production Team! Processing Fee ($20 per horse) Price: Subtotal $ 0.00 Coupon Credit Card Fees $ 0.00 Total REQUIRED LIABILITY RELEASE* Yes, I agree I understand that credit card fees and online entry fee is NON-REFUNDABLE. Also, under MIssissippi law, an equine activity sponsor is not liable for an injury to, or the death of, a participant in equine activities resulting from the inherent risk of equine activities. I understand that every effort will be made to ensure the safety of each contestant and his/her horse(s). I hereby release LanBar Barrel Racing, Kirk-Fordice Equestrian and all sponsors involved. I also acknowledge that I have read, understand, and agree to abide by the rules ofLan Bar Barrel Racing and any ground rules enforced for specific events. (See website and/or registration table for rules and complete event details.)Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name Comments to Producer -- NO EMOJIs! Or we can't print your entryPlease check your email after submitting your entry for confirmation.CAPTCHA
