Night Jackpot Entry Form
No Online entries after 12:00 p.m. the day of the event!
Event:
Date:
Name:
Email:
Address:
City:
State:
Zip:
Phone:
Dashes are required in Phone# - Example: 555-555-5555
(** Must Present SSN Number at Arena in order to receive payback**)
Horse 1:
Horse 2:
Horse 3:
Please check each event that will be entered for each horse.
Please note that a $5.00 office fee applies for each horse for each day
.
06/14/2023
Horse #1
Horse #2
Horse #3
4D Barrels
$25.00
Jr. Barrels *
(18 and under)
$20.00
2nd Open 4D
$20.00
Office Fee *
$5.00
*You may carry/roll over your time from previous class if you note it in the comments section what you want to do.
Questions or Comments
By checking this box I acknowledge that I am over the age of 18 and I agree and have read the
Hard Hat Release Waiver
.
Enter text as shown in image above
