2019 The NWHA National
September 16 - 21, 2019 Calsonic Arena, Shelbyville, TN
Pre-entries close 9/8/19
Email address *
Current NWHA Membership REQUIRED to exhibit at the National
Person Responsible for bill on these horses.
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Owner full name:
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Owner address:
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Owner city, state, zip
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Owner NWHA number:
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Owner phone:
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Owner farm/ranch/stable name:
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Owner E-mail
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Trainer name:
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Trainer full name:
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Trainer full address (include city, state, zip)
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Trainer phone:
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Trainer Farm/Stable/Ranch:
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Trainer NWHA number:
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Trainer E-mail:
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Horse A Name:
Horse A
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Horse A - Breed
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Horse A - Registraion #
Your answer
Horse A - Foal Date
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DD
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Horse A - Sex
Horse A - COGGINS - Owner on coggins
MUST SUBMIT COPY OF COGGINS AT CHECK IN
Your answer
Horse A - COGGINS - Horse name on coggins
Your answer
Horse A - COGGINS - Accession Number
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Horse A - COGGINS - Date Blood Drawn
MM
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DD
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YYYY
Horse A - COGGINS - Laboratory
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Horse B - Name:
Horse B
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Horse B - Breed
Your answer
Horse B - Registraion #
Your answer
Horse B - Foal Date
Your answer
Horse B - Sex
Horse B - COGGINS - Owner on coggins
MUST SUBMIT COPY OF COGGINS AT CHECK IN
Your answer
Horse B - COGGINS - Horse name on coggins
Your answer
Horse B - COGGINS - Accession Number
Your answer
Horse B - COGGINS - Date Blood Drawn
MM
/
DD
/
YYYY
Horse B - COGGINS - Laboratory
Your answer
Horse C - Name:
Horse C
Your answer
Horse C - Breed
Your answer
Horse C - Registraion #
Your answer
Horse C - Foal Date
Your answer
Horse C - Sex
Horse C - COGGINS - Owner on coggins
MUST SUBMIT COPY OF COGGINS AT CHECK IN
Your answer
Horse C - COGGINS - Horse name on coggins
Your answer
Horse C - COGGINS - Accession Number
Your answer
Horse C - COGGINS - Date Blood Drawn
MM
/
DD
/
YYYY
Horse C - COGGINS - Laboratory
Your answer
Exhibitor A Full Name
Exhibitor A
Your answer
Exhibitor A Full Address (include city, state, zip)
Your answer
Exhibitor A Adult or Youth
Exhibitor A DOB (IF YOUTH)
MM
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DD
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YYYY
Exhibitor A NWHA Number:
Your answer
Exhibitor A Phone Number:
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Exhibitor A E-mail:
Your answer
Exhibitor A Classes for HORSE A: (example 1, 5, 22, 105...)
Your answer
Exhibitor A Classes for HORSE B: (example 1, 5, 22, 105...)
Your answer
Exhibitor A Classes for HORSE C: (example 1, 5, 22, 105...)
Your answer
Exhibitor B Full Name:
Exhibitor B
Your answer
Exhibitor B Full Address (include city, state, zip):
Your answer
Exhibitor B Adult or Youth:
Exhibitor B DOB (IF YOUTH)
MM
/
DD
/
YYYY
Exhibitor B NWHA Number
Your answer
Exhibitor B Phone Number
Your answer
Exhibitor B E-mail:
Your answer
Exhibitor B Classes for HORSE A: (example 1, 5, 22, 105...)
Your answer
Exhibitor B Classes for HORSE B: (example 1, 5, 22, 105...)
Your answer
Exhibitor B Classes for HORSE C: (example 1, 5, 22, 105...)
Your answer
Exhibitor C Full Name:
Exhibitor C
Your answer
Exhibitor C Full Address (include city, state, zip):
Your answer
Exhibitor C Adult or Youth:
Exhibitor C DOB (IF YOUTH
MM
/
DD
/
YYYY
Exhibitor C NWHA Number:
Your answer
Exhibitor C Phone Number:
Your answer
Exhibitor C E-mail:
Your answer
Exhibitor C Classes for HORSE A: (example 1, 5, 22, 105...)
Your answer
Exhibitor C Classes for HORSE B: (example 1, 5, 22, 105...)
Your answer
Exhibitor C Classes for HORSE C: (example 1, 5, 22, 105...)
Your answer
Grounds fee - $20 per horse per day (for horse WITHOUT a stall) Horse name and how many days?
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Stalls $135 for 9/15 - 9/22 (after 9/8 $150):
This will charge your bill, it will NOT reserve your stall. To reserve stall, please contact Merleene Pacheco at bearcat66@icloud.com
Your answer
Stall early arrival/late departure $30 per day (day and time of arrival and day of departure):
This will NOT reserve your stall contact Merleene Pacheco at bearcat66@icloud.com
Your answer
Stall four or less days $30 per day, $35 after 9/8 (Please provide the number of stalls and days you need them)
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Bedding $8 pre ordered - $10 after 9/8 - number of bales/bags
Your answer
Camper/RV Sites $250 9/15-9/22 (after 9/8 $275)
This will NOT reserve your RV contact Mag Ranft at magranft@hotmail.com
Your answer
Camper/RV Sites Early arrival/late departure $40 per day (day and time of arrival - day of departure)
This will NOT reserve your RV contact Mag Ranft at magranft@hotmail.com
Your answer
Camper/RV Sites four or less days $40 per day (days you will need RV site, number of days) $50 per day after 9/8
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Do you or one of your riders need a membership? (Name and type of membership)
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Please consider a Sponsorship. Any amount helps NWHA with their mission.
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Comments - Requests - Questions -
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By submitting your entry, you agree to the following Release and Waiver: As owner, agent or guardian, I certify that the information provided on this entry form is correct and I agree to indemnify and hold harmless The NWHA, the National and the Calsonic Arena, the managers and their respective agents, contractors, officers, employees, directors, shareholders and assigns from all responsibility to horses, persons, and/or equipment arising from any connection with this show. It is understood and agreed that participants will be solely responsible for any consequential or other loss, injury, or damage incurred while participating in this event. WARNING: Under Tennessee Law, an equine professional is not liable for an injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities, pursuant to Tennessee Code Annotated, title 44, chapter 20.
A copy of your responses will be emailed to the address you provided.
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