PLEASE TYPE OR PRINT Extra forms available at our website - http://neisca.org NEISCA CLOSED Breeders Futurity Nomination Form Only Get of Sire, Open Futurity Classes Nomination Form Only Date of Nomination _______________ [Get of Sire classes open only to stallions sold on the NEISCA Breeders Futurity in 2006, 2007, 2008, 2009.] Get Of Sire/Open Fees: Per Entry - $35 if received by June 1; $50 if received by July 1; $75 if received by Aug. 1; $100 Aug. 2 to the day of show. This entry is a (check all that apply for this horse - one horse per sheet): ____ Get of Sire Weanling Halter fillies_____ studs_____ ____ Open Weanling Halter fillies_____ studs_____ ____ Get of Sire Yearling Halter filly_____ stud/gelding_____ ____ Open Yearling Halter filly_____ stud/gelding_____ ____ Get of Sire 2 Yr Old Halter (any sex) ____ Get of Sire Yearling Longe Line ____ Open Yearling Longe Line ____ Get of Sire Two Year Old Snaffle/Bosal ____ Open Two Year Old Snaffle/Bosal ____ 3, 4, & 5 Yr Olds Get of Sire Junior Western Pleasure, Any Bit Horse’s Name: ________________________________________ Foaling Date: __________________________ Sex - M G S Sire: _______________________________________________ Dam: ______________________________________________ Include one of the following: ___ Copy of Registration Papers ___ Vet Certificate ___ Copy of Registration Application ___ 2009 Dues if not already paid If no papers yet a Reg. Application or Vet Certificate must be completely filled out with foaling date, sex, color, markings, etc. Please check which one of the above papers has been included with this entry. Yearling/2YO entries must be accompanied by a copy of registration papers only - no applications. If it is a grade horse, breeders certificate is required from the stallion owner along with a vet certificate stating foaling date, color, markings. ___ Jumpout $7 per day, overnight horses must be stalled ___ Stall - $30 per day ___ Stall - $35 per weekend ___ Bedding - $6/bag (subject to change) ___ Camping $15 per night - primitive or 30 amp service ___ Camping $25 per night - 50 amp service ___ Trailer Fee $1 ___ Jumpout/stalls/bedding/Camping & Trailer on separate check Owner: ___________________________ SS#: _______________ Phone #: (______)_____________________________ Address: _____________________________________________ City/St/Zip: __________________________________________ Email: ______________________________________________ Exhibitor: ___________________________________________ NEISCA club membership (must be a 2009 member of a NEISCA club at time of entry or pay Associate Membership fee of $10) List NEISCA club: ____________________________________ Associate Membership Fee ($10): $____________ ALL ENTRIES $____________ STALLS/JUMPOUT/DUES/CAMPING $____________ Mail to: Judy Smith 4351 Spencer Grove Rd. Walker, IA 52352 Date of Nomination _______________ Weanlings Only - Must have been nominated to Show! Fees: $5 office charge plus jumpout or stall feees (pay below). _____ 2009 Weanling Closed Entry submitting office charge and jumpout or stall money. Studs _____ Fillies _____ *Owner & Exhibitor: Must have paid NEISCA Club or Assoicate dues. Exhibitor must be a relative of the owner in accordance with Rules H21 & H24. Ongoing Fees: Per Entry - $35 if received by June 1; $50 if received by July 1; $75 if received by Aug. 1; $100 Aug. 2 to the day of show. This entry is a: (check all that apply for this horse) [Open to ONLY Horses NOMINATED AS FOALS] ____ Closed Breeders Yearlings Fillies ____ Closed Breeders Yearling Colts/Geldings ____ Closed Yearling Longe Line ____ Closed Breeders Two Year Old Sn/Bosal Horse’s Name: ________________________________________ Foaling Date: __________________________ Sex - M G S Sire: _______________________________________________ Dam: ______________________________________________ Include one of the following: ___ Copy of Registration Papers ___ Vet Certificate ___ Copy of Registration Application ___ 2009 Dues if not already paid If no papers yet a Reg. Application or Vet Certificate must be completely filled out with foaling date, sex, color, markings, etc. Please check which one of the above papers has been included with this entry. Closed Breeders Futurity Yearling/2YO entries must be accompanied by a copy of registration papers only - no applications. If it is a grade horse, breeders certificate is required from the stallion owner along with a vet certificate stating foaling date, color, markings. ___ Jumpout $7 per day, overnight horses must be stalled ___ Stall - $30 per day ___ Stall - $35 per weekend ___ Bedding - $6/bag (subject to change) ___ Camping $15 per night - primitive or 30 amp service ___ Camping $25 per night - 50 amp service ___ Trailer Fee $1 ___ Jumpout/stalls/bedding/Camping & Trailer on separate check Owner: ___________________________ SS#: _______________ Phone #: (______)_____________________________ Address: _____________________________________________ City/St/Zip: __________________________________________ Email: ______________________________________________ Exhibitor: ___________________________________________ NEISCA club membership (must be a 2009 member of a NEISCA club at time of entry or pay Associate Membership fee of $10) List NEISCA club: ____________________________________ Associate Membership Fee ($10): $____________ ALL ENTRIES/OFFICE CHARGE $____________ STALLS/JUMPOUT/DUES/CAMPING $____________ Mail to: Judy Smith 4351 Spencer Grove Rd. Walker, IA 52352 Make checks payable to NEISCA. Make checks payable to NEISCA.