Name of Individual Responsible for Payment of Tabsheet

Back# ILLINOIS PAINT HORSE ASSOCIATION/INDIANA PAINT HORSE CLUB Entered in Computer ____ ENTRY FORM/TABSHEET to be used at September 2-3, 2017 Gifford, IL show only

THIS PRE-ENTRY FORM TO BE USED ONLY FOR SEPTEMBER 2-3, 2017 SHOW AT GORDYVILLE USA, GIFFORD, IL

NO office fee charged if pre-entry form is postmarked or emailed to Jerry Wyrick by midnight 8/30/2017. Pre-entry will also automatically enter you in the random drawings for two free stalls at show.

Please complete pre-entry form and email to: [email protected]. Pre-entry form can also be printed and completed. Please mail printed form to: Jerry Wyrick, 12336 N 2850 East Rd., Ellsworth, IL 61737

DO NOT SEND A CHECK FOR YOUR PRE-ENTRIES.

This form should not be used to request stalls. Please submit the Prepaid Stall Reservation form located on www.illinoispainthorse.com with your check. Stall checks will not be cashed until the next business day after the horse show. For questions, please contact Jerry Wyrick at (309) 826-3643.

Name of Individual Responsible for Payment of Tabsheet Yes, please email my receipt to me at (email address):

Stalls Reserved Under: (A) Open Exhibitor APHA Membership # City, State Date of Show __September 2-3, 2017______Relationship to Owner Show Location __Gifford, IL______(B) Amateur Exhibitor APHA Membership # Horse’s Name Amateur #/Date of Birth / Horse’s APHA # City, State Registry: Regular Solid Paint Bred Relationship to Owner Year Foaled M G S (C) Youth Exhibitor Coggins Date: APHA Membership # Owner Youth # Address Youth Date of Birth City, State, ZIP City, State Phone Relationship to Owner

Total Amount of All Day Fees From Reverse Side ______X Number of Judges (__4___) ______Total Amount of Class Fees From Reverse Side ______X Number of Judges (__4___) ______APHA Fees - $5 per judge X Number of Judges (_4_) 20.00

Number of stalls (____) x Stall fee ($50) OR Jumpout Fee (___$5.00____) ______Misc Fees (Electrical ______, Other ______) ______IPHA Office Fee ($5 per horse) 5.00 Permanent Number Fee, $5/$7 (laminated), proceeds to IJPHC. Number(s) ______2017 IPHA Membership Paid? Yes No (Youth $10, Single $15, Family/Business $20) 10 / 15 / 20 Total Amount Due (Paid: Cash ______Check# ______) ______Name of responsible party: Horse Name:

Exh $7/class or $40 all-day fee (one horse/one Exh $7/class or $40 all-day fee (one horse/one Exh $7/class or $40 all-day fee (one horse/one A, B rider) A, B rider) A, B rider) or C Shaded class not eligible for all day fee or C Shaded class not eligible for all day fee or C Shaded class not eligible for all day fee 1. Amateur Stallions 49. Walk Trot Hunter Under Saddle (5-10) 97. Open Walk Trot (NON-APHA) 2. Weanling Stallions 50. Walk Trot Hunt Seat Equitation (5-10) 98. Walk Trot Western Pleasure (5-10) 3. Yearling Stallions 51. Amateur Walk Trot Hunter Under Saddle 99. Walk Trot Horsemanship (5-10) 4. 2 Year Old Stallions 52. Amateur Walk-Trot Hunt Seat Equitation 100. Amateur Walk-Trot Horsemanship 5. 3 Year Old Stallions 53. Green Hunter Under Saddle 101. Amateur Walk Trot Western Pleasure 6. Aged Stallions 54. Novice Youth Hunter Under Saddle 102. Green Western Pleasure 7. Amateur Solid Paint Bred Stallions 55. Novice Amateur Hunter Under Saddle 103. Novice Youth Western Pleasure 8. Solid Paint Bred Stallions 2 Year Old & Under 56. Youth Hunter Under Saddle (13 & Under) 104. Novice Amateur Western Pleasure 9. Solid Paint Bred Stallions 3 Year Old & Over 57. Youth Hunter Under Saddle (14-18) 105. Junior Western Pleasure 10. Youth Geldings 58. Amateur Hunter Under Saddle (19 & Over) 106. Youth Western Pleasure (13 & Under) 59. Amateur Masters Hunter Under Saddle 11. Amateur Geldings 107. Youth Western Pleasure (14-18) (45 & Over) 12. Weanling Geldings 60. Junior Hunter Under Saddle 108. Amateur Western Pleasure (19 & Over) 13. Yearling Geldings 61. Youth Solid Paint Bred Hunter Under Saddle 109. Amateur Masters Western Pleasure (45 & Over) 14. 2 Year Old Geldings 62. Amateur Solid Paint Bred Hunter Under Saddle 110. Youth Solid Paint Bred Western Pleasure 15. 3 Year Old Geldings 63. Solid Paint Bred Hunter Under Saddle 111. Amateur Solid Paint Bred Western Pleasure 16. Aged Geldings 64. Senior Hunter Under Saddle 112. Solid Paint Bred Western Pleasure 17. Youth Solid Paint Bred Geldings 65. Novice Youth Hunt Seat Equitation 113. Senior Western Pleasure 18. Amateur Solid Paint Bred Geldings 66. Novice Amateur Hunt Seat Equitation 114. Novice Youth Horsemanship 19. Solid Paint Bred Geldings 2 Year Old & Under 67. Youth Hunt Seat Equitation (13 & Under) 115. Novice Amateur Horsemanship 20. Solid Paint Bred Geldings 3 Year Old & Over 68. Youth Hunt Seat Equitation (14-18) 116. Youth Western Horsemanship (13 & Under) 21. Overo Color 69. Amateur Hunt Seat Equitation 117. Youth Western Horsemanship (14-18) 22. Tobiano Color 70. Youth Solid Paint Bred Hunt Seat Equitation 118. Amateur Horsemanship 23. Walk Trot Showmanship (5-10) 71. Amateur Solid Paint Bred Hunt Seat Equitation 119. Youth Solid Paint Bred Horsemanship 24. Amateur Walk Trot Showmanship 72. Youth Hunter Hack 120. Amateur Solid Paint Bred Horsemanship 25. Novice Youth Showmanship 73. Amateur Hunter Hack 121. Green Western Riding 26. Novice Amateur Showmanship 74. Hunter Hack 122. Youth Western Riding 27. Youth Showmanship (13 & Under) 75. Solid Paint Bred Hunter Hack 123. Amateur Western Riding 28. Youth Showmanship (14-18) 76. Youth Ranch Riding 124. Western Riding 29. Amateur Showmanship (19 & Over) 77. Amateur Ranch Riding 125. Youth Reining 30. Amateur Masters Showmanship (45 & Over) 78. Ranch Riding 126. Amateur Reining 31. Youth Solid Paint Bred Showmanship 79. Solid Paint Bred Hunter Hack 127. Reining 32. Amateur Solid Paint Bred Showmanship 80. Youth Ranch Trail 128. Youth Pole Bending 33. Youth Mares 81. Amateur Ranch Trail 129. Amateur Pole Bending 34. Amateur Mares 82. Ranch Trail 130. Pole Bending 35. Weanling Mares 83. Solid Paint Bred Ranch Trail 131. Youth Solid Paint Bred Pole Bending 36. Yearling Mares 84. Yearling In-Hand Trail 132. Amateur Solid Paint Bred Pole Bending 37. 2 Year Old Mares 85. Walk Trot Trail (5-10) 133. Solid Paint Bred Pole Bending 38. 3 Year Old Mares 86. Amateur Walk-Trot Trail 134. Youth Stake Race 39. Aged Mares 87. Green Trail 135. Amateur Stake Race 40. Broodmares 88. Novice Youth Trail 136. Stake Race 41. Youth Solid Paint Bred Mares 89. Novice Amateur Trail 137. Youth Solid Paint Bred Stake Race 42. Amateur Solid Paint Bred Mares 90. Youth Trail 138. Amateur Solid Paint Bred Stake Race 43. Solid Paint Bred Mares 2 Year Old & Under 91. Amateur Trail 139. Solid Paint Bred Stake Race 44. Solid Paint Bred Mares 3 Year Old & Over 92. Trail 140. Youth Barrel Racing 45. Lead Line (3-8) 93. Youth Solid Paint Bred Trail 141. Amateur Barrel Racing 46. Amateur Yearling Longe Line (May, Sept only) 94. Amateur Solid Paint Bred Trail 142. Barrel Racing 47. Yearling Longe Line (May, Sept only) 95. Solid Paint Bred Trail 143. Youth Solid Paint Bred Barrel Racing 96. Two Year Old Snaffle Bit Western Pleasure 48. Solid Paint Bred Longe Line (May, Sept only) 144. Amateur Solid Paint Bred Barrel Racing (May & Sept only) 145. Solid Paint Bred Barrel Racing