Mid-America Breeder's Futurity Entry Form

Stallion Name

Reg. No.

Mare Name

Reg. No.

Foals Name

Reg. No.

Date Foaled

Sex

Owner

Address

City, State, Zip

Phone

Exhibitor

Classes Entered:

Weanling      Yearling Halter      Lounge Line      2 yr old Halter      Snaffle Bit

$50 entry fee must accompany entry form

A copy of Registration Papers or Breeder's Certificate must be enclosed

Entries must be received by July 1, 2009

Late entries will be accepted until August 1, 2009 with a $25 late fee

No entries will be accepted after August 1, 2009

Send Entries to:

Felisha Ellis

14415 State Route E

Agency, MO 64401