NOMINATION FORM
MASSACHUSETTS 4-H STONE HORSES® MODEL
Here’s your opportunity to tell us why your horse should be a Stone Horses® Model!
To nominate your horse as the Massachusetts 4-H Stone Horses® Model, you must:
1. Complete this nomination form;
2. Submit pictures of your horse, including full left view; full right view; full front
view; full rear view; and face close-up (Photos cannot be returned and become the
property of Massachusetts 4-H and The Peter Stone Company).
3. Submit a letter from your 4-H leader, supporting your horse’s nomination.
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Your information:
Name___________________________________________________________________
Address_________________________________________________________________
City__________________ State______ Zip_________ Date of Birth _______________
Phone (______) ______________________ E-mail ______________________________
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Your Horse’s Information:
Name_________________________________________________ Gender ___________
Age _____________ Breed ______________________ Color _____________________
Markings _______________________________________________________________
_______________________________________________________________________
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My horse should be selected the 2012 Peter Stone 4-H Horse because (maximum 1,000
typed words)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
By signing below, I acknowledge that the Peter Stone Company has permission to
reproduce my horse’s name and likeness on a model of an existing mold. My name may
also be used as the owner of the horse. My sole compensation for this right will be to
receive one (1) model at no charge.
_________________________ _____________________ _______________________
Signature of Owner of Horse
Signature of 4-H Member
Signature of 4-H Parent/Guardian
Nomination Form and Supporting Documents must be sent to:
Patricia E. Wagner
362 North East Street
Amherst, MA 01002
ENTRIES MUST BE POSTMARKED BY SEPTEMBER 21, 2012
Questions: pwagner362@hotmail.com or by phone at 413-537-5626