PEE_WEE 1-9 YEARS OLD

DATE _____________ ONE FORM PER HORSE PLEASE

NAME_________________________________________________________Pee Wee Entry $ 10.00______

ADDRESS______________________________________________ _Non-Member Fee ($5)____________

CITY, ZIP______________________________________________________

HORSE ___________________________________________________ONE TIME ONLY __FREE_______

Pee Wee MEMBER (CIRCLE ONE) TIME ONLY (3.00@)_ $3 x ______ = _______________

YES NO OTHER CREDITS OR DEBTS______________

YEARLY MEMBERSHIP FEE $25.00

TOTAL FEES OWED $_____________

UPON ENTERING THIS BARREL RACE I ASSUME FULL RESPONSIBILITY FOR MYSELF, MY ANIMALS AND ANY PERSON CONNECTED WITH ME DURING MY TIME AT THE CCOBRA EVENT. I ALSO RELEASE AND HOLD HARMLESS THE ARENA OWNER/OPERATORS AND ANY PERSON CONNECTED WITH THE PRODUCTION OF THIS EVENT FROM LOSS, DAMAGE, INJURY OR DEATH.

SIGNATURE (IF SIGNING FOR Pee Wee SO STATE.)