AAY ENTRY FORMS

Unique ID

Date of Birth*

Required to calculate sidepots.

Name

First Last

Entry Date

Email*

Phone

SSN*

Credit Card Billing Address*

Street Address City State ZIP Code

Rider Mailing Address*

Street Address City State ZIP Code

Entry Options

Entry Horse 1

Price: $0.00

Entry Horse 2

Price: $0.00

Entry Horse 3

Price: $0.00

Entry Horse 4

Price: $0.00

How many horses will you be entering?*

Horse #1 Name

AAY Fees Horse 1

$200 Entry Fee
$50 Sidepot
$100 Pony Race

NOTE: You cannot select the $50 SIdepot without the $200 Entry Fee.

Horse #2 Name

AAY Fees Horse 2

$200 Entry Fee
$50 Sidepot
$100 Pony Race

NOTE: You cannot select the $50 SIdepot without the $200 Entry Fee.

Horse #3 Name

AAY Fees Horse 3

$200 Entry Fee
$50 Sidepot
$100 Pony Race

NOTE: You cannot select the $50 SIdepot without the $200 Entry Fee.

Horse #4 Name

AAY Fees Horse 4

$200 Entry Fee
$50 Sidepot
$100 Pony Race

NOTE: You cannot select the $50 SIdepot without the $200 Entry Fee.

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.

Stall Reservations ($85 ea)

Stalls

Price: $85.00 Quantity:

Late Fees

Price: $0.00

Online Entry Fee plus AAY Text & Alerts

Price: $3.00

Don't miss important text alerts from the LanBar Production Team!

Processing Fee ($20 per horse)

Price: $20.00

Subtotal

$0.00

Coupon

Credit Card Fees

$0.00

Total

$0.00

REQUIRED LIABILITY RELEASE*

Yes, I agree

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 Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Side Pot Eligibility Teen

Side Pot Eligibility Youth

Comments to Producer

AAY ENTRY FORMS

All-American Youth Entry Form 2020

Entry Options

Stall Reservations ($85 ea)

Please check your email after submitting your entry for confirmation.