West Virginia Registration Application For

West Virginia Registration Application for Thoroughbred Breeders Association West Virginia P. O. Box 626 Charles Town WV 25414 Bred and/or Sired 304.728.6868 Fax 304.724.7870 www.wvtba.com

Registered Name: ______Sire: ______

Color: ______Sex: ______Mare: ______

Date of Foaling: ______Sire of Mare: ______

Jockey Club Registration #: ______WV Resident Mare: (___) Yes (___) No ------Farm where this mare was covered by sire of this horse ______Phone: ______

Address: ______City: ______State: ____ Zip: ______

Farm where this mare foaled ______Phone: ______

Address: ______City: ______State: ____ Zip: ______

Following the birth of this foal, this mare was covered by ______or, not bred (___)

Farm where mare resided during foaling year ______Owner ______Phone: ______

Address: ______City: ______State: ____ Zip: ______------BREEDER OWNER (if different)

Name ______Name ______

Address: ______Address: ______

______

Phone: ______Phone: ______

Registrations must be postmarked no later than December 31 to be eligible for lower fees. Please see the West Virginia Thoroughbred Development Fund Registration rules form. Certificates will be issued 7 - 10 days after original registration application. Information provided is subject to review by the West Virginia Racing Commission

PLEASE MAIL THE REQUIRED PAPERWORK AND YOUR CHECK OR MONEY ORDER PAYABLE TO THE WVTBA TO THE ADDRESS ABOVE.

By Signing below I certify and attest that all of the information given above is true and correct as of the date of signing, and further that I understand that in the event of falsification of any of the above information, I shall be subject to be punished to the full extent of the authority of the WVRC.

Signature of Owner or Authorized Representative ______Date ______

OFFICE USE: WV Registration # ______SIRE OWNER at time of cover :______Resident mare verified:______To Register West Virginia Bred and/or Sired

1. Must meet criteria set forth by the West Virginia Thoroughbred Development Fund (WV Code 19- 23-13b) 2. Must provide a copy of the Jockey Club Papers. 3. Copy of the Affidavit of a mare foaling in West Virginia if required (non-resident mares only) 4. Official Bill of sale if ownership of horse has changed since the Jockey Club papers were issued. 5. All registrations subject to review by the WV Racing Commission.

To be eligible to participate in the West Virginia restricted races and to receive bonus money from the West Virginia Thoroughbred Development Fund, all horses must be registered with the West Virginia Thoroughbred Breeders Association.

Fees for Registration of Foals

Members Non-Members (dues postmarked prior to Jan 1) (dues postmarked after Jan 1)

Weanling-Yearlings $75.00 $200.00 Two-Year Olds and Older $150.00 $300.00

THIS IS A ONE TIME REGISTRATION