2015 NJPEA Entry Form
___Sat_____Sun
For Office Use Only
Payment:_______Cash _______Check #_______
Amt. Paid _______________Amt. Owed ________________
IF STALLED WITH OR BILLING WITH A FARM ENTER FARM NAME
HORSE’S NAME
Year Foaled
Owner(s) as on registration papers
Owner(s) PHBA# (required)
Owner(s) Address
Phone #
Entry Number _________________
_____Coggins _____Health Certificate
_____PHBA (current) ____ Registration
REG. #
Sex
email address
PHBA OPEN AND AMATEUR CLASS INFORMATION
OPEN CLASS NUMBERS _____ _____ _____ _____ _____ _____ _____ _____ _____ ____ _____ _____ _____ _____ ______ _____ _____ _____
AMATEUR CLASS NUMBERS _____ _____ _____ _____ _____ _____ _____ _____ _____ ____ _____ _____ _____ _____ ______ _____ _____
Exhibitor Name
Address
Phone #
email address
Exhibitor PHBA Number
Back fee
$150.00/$165.00/$175.00
#Classes_____ x $25
TOTAL
OPEN TO ALL CLASS INFORMATION
OPEN TO ALL CLASS NUMBERS _____ _____ _____ _____ _____ _____ _____ _____ _____ ___
Exhibitor Name
Address
Phone #
email address
#Classes ______x $10
TOTAL
PHBA YOUTH CLASSES
CLASS NUMBERS _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____
Exhibitor Name
DOB
Address
Phone #
email address
Exhibitor PHBA Number
Relationship to Owner
Back fee
$150.00/$165.00/$175.00
#Classes_______ x $20
TOTAL
Open To All Classes $10 per class, per day 1 judge
PHBA Open and Amateur Entry Fees per class $25
PHBA Youth Entry Fees per class $20
Show fees: 30+ Horses (meeting the back fee) $150 per horse per day
25 – 29 Horses (meeting the back fee) $165 per horse per day
1 - 24 horses (meeting the back fee) $175 per horse per day
NJPEA and the Dream Park will not be held responsible for any injuries that
occur to horses, spectators, vehicles etc. Entry must be signed by exhibitor or
if youth 18 and under by parent, guardian or responsible party and shall serve
as release of liability.
__________
TOTAL ENTRY FEES
NJPEA OFFICE FEE $18/day/horse
TOTAL__________
Open to All OFFICE FEE $6/day/horse
TOTAL__________
PHBA Computer/Drug Fee $18 per day/horse ______TOTAL________
STALL FEE $60 before 5/15 $80 after 5/15 ___________
CAMPER FEE $75 (before 5/15) $95 after 5/15 _______
Showing from trailer $20 per day
TOTAL
EXHIBITOR SIGNATURE
Submit completed form to wunspot@aol.com
February 2015 Exhibitor Entry Form
Lori Wunderlich 55 Carriage Lane Newton, NJ 07860