Official Entry Form

Reg # Sex DOB

Class

No's

Reg # Sex DOB

Class

No's

Reg # Sex DOB

Class

No's

Reg # Sex DOB

Class

No's

Owner/

Exhibitor:

$12.00

Yards @ $15 each: Phone No:

Email:

Signature:

Address:

Sub Total of Entries:

Admin & Catalogue:

Total of Entries:

Ground Fee @ $10 ech

Stables @ $30 each:

Entry Fee: - $10 Members (NZWA)

- $15 Non-Members Per ClassEntries will only be accepted if:

* Entry is correct & the Admin Fee ($12) is included

* Payment of a ground levy of $10/horse is included

* Full payment of entries is received. Incorrect entries will be

returned & may be refused.

Name Of Horse Name of Breeder Name of Rider Sire/Dam

Name Of Horse Name of Breeder Name of Rider Sire/Dam

Name Of Horse Name of Breeder Name of Rider Sire/Dam

SOUTH ISLAND WARMBLOOD CHAMPIONSHIP SHOW

Sunday 1st November 2015

Entries Close: Wednesday 28th October 2015 Entries to siwbshow@hotmail.com

or post to SI WB Show, 862 Oxford Road, RD1 Rangiora 7471. Direct deposit using your surname as reference: 01 0141 0050693 02

All enquiries to Michelle Zielazo 0272 540 574, Please call between 5pm & 9pm.

Name Of Horse Name of Breeder Name of Rider Sire/Dam

Please note that these entries are subject to the conditions regulations of the South Island Warmblood Show. The signing of this Entry Form will deem that the rules conditions of the

show are accepted.