MPAA Saturday, October 16 Jackpot Barrel Entry Form
Preregistration will be taken up until 10:00 PM on Friday night. After that time, we will shut off preregistration and you will have to register at the crows nest the day of the event.
Sign in to Google
to save your progress.
Name (first name, last name)
Name of Horse
Number of Exhibitions (Used in any combination for barrels and/or pole exhibitions)
Events: Check all that apply to ONLY the horse and rider above. Add each event price to your total
PeeWee 1 ($5.00)
PeeWee 2 ($5.00)
Open 1 ($20.00)
Open 2 ($20.00)
Youth 1 ($15.00)
Youth 2 ($15.00)
Furturity Side Pot 1 ($10.00)
Furturity Side Pot 2 ($10.00)
Derby Side Pot 1 ($10.00)
Derby Side Pot 2 ($10.00)
Carry Open 1 to Youth 1
Carry Open 1 to Open 2
Carry Youth 1 to Youth 2
Carry Open 2 to Youth 2
Office Fee ($5.00)
My child is running PeeWee, no office fee
Yes (add $5.00 to your total)
I would like to participate in series end awards. (More details can be found on
Yes - $25 for youth
Yes - $25 for open
Yes - $10 PeeWee
No, I do not want to participate in series end awards.
I have already paid to participate in year end awards. (this will be verified)
Add the total amount from Office Fee, Exhibitions, Events, and optional series end award fee and type in the box below:
Is the rider a member of the PEWC?
The rider is a PAID MPAA member (This means you have ACTUALLY PAID your membership, not that you are GOING TO pay your membership)
No and I will fill out the membership form:
any pay by cash or check the day of the event.
This is a CASH ONLY jackpot. I will bring the EXACT AMOUNT of CASH with me on the day of the jackpot.
The Equine Activity Liability laws of the State of North Dakota, §53-10-02, state among its statutory provisions that “Except as provided in Subsection 2, an equine activity sponsor or an equine professional is not liable for an injury to or the death of a participant engaged in an equine activity, and, except as provided in subsection 2, no participant or participant’s representative may maintain an action against or recover from an equine activity sponsor or an equine professional for an injury to or the death of a participant engaged in an equine activity." I, having read and understood the content of this document, agree and consent to the provisions contained herein.
I will clean up after myself and horse(s) prior to leaving the grounds. I understand that failure to do so will result in me being banned from any further MPAA events for the 2021 season with no-refunds given.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service