Exhibitor Name: 2015 Utah POA ALL-BREED Show Entry Form Address: # Circle age group Birthday City, State, Zip code 6 &U 9 &U 10-13 14-18 19 &O ______/_______/______ Phone Number: Check Gender: Email address: Male_____ Female_____ Horse/Pony Name: Registration #: Height: PHC:_____ Circle: Year Foaled: Pony Owner: Mare/Gelding/Stallion Circle class #’s 1 3 4 5 8 10 11 12 13 16 18 19 20 23 24 25 26 27 28 29 30 31 32 33 34 35 114 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 115 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 116 Select Show: 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 117 May 16 @ North County Equestrian Park in Highland June 27th @ the Wahoo arena in Salem August 22th @ Legacy Event Center in Layton September 12th @ The Spanish Fork Fairgrounds in Spanish Fork PRE-ENTERED CLASSES_____X $4 =$__________ LATE ENTERED CLASSES_____X $6 =$__________ UTAH POA MEMBER FEE $5 =$__________ POA NATIONAL FEE $4 =$__________ NON-POA MEMBER FEE =$__________ TOTAL =$__________ FOR ENTRIES TO BE CONSIDERED EARLY THEY MUST BE RECEIVED BY MIDNIGHT THE SUNDAY BEFORE EACH SHOW! Mail Entries and Payment to: Utah POAC Show Secretary Heidi Steeneck 1590 N 300 E Lehi, UT 84043 For more information contact me at: utpoacshowsecretary@gmail.com Make checks payable to Utah POAC Online Entries Accepted at www.UtahPOA.org I agree that such entries are made at my own risk and subject to the rules of this show, and of the Pony of the Americas Club, Inc., and I agree, for myself and my representatives to be bound thereby. I further agree to assume and accept full risk of injury or damage to property or myself, which may be sustained at the show. I further waive any cause of action that I might or could have by reason of said damages to myself, my family, or property as against the grounds owner, the POAC, Inc., the host state (Utah POA), or any of the officers, directors, or members of said associations. I further agree that the show manager has the right to interpret all questions or conditions in regard to dispute regarding interpretations of the proper color or height to show. No entry fees will be returned except by proper official certificate of illness of pony or rider by veterinarian or physician. This will serve as my consent of children of minor age to enter this show. I verify that all information that I have supplied on this form is correct and complete. I have read and understand the show rules and have completed all necessary designation forms that are required for this entry. ______________________________________________________________________ Signature of rider or authorized guardian if under 18 Date: ________________________________