Open Entry Form

THIS IS NOT AN ON-LINE SUBMISSION FORM. PLEASE COMPLETE FORM, THEN PRINT AND MAIL BACK TO: CORNHUSKER FUTURITY, 44080 Dr. 796, BROKEN BOW, NE 68822

	Cornhusker Open Futurity and Derby/Maturity August 17-19, 2012 Custer Co. Fairgrounds, Broken Bow, NE

	Open Futurity Entry Form
Horse's Name			Reg. #
Year Foaled		Sex	Color
Sire			Dam
Owner Name			Rider Name
Address			Address
City/St/Zip			City/St/Zip
Phone			Phone
E-mail			E-mail

	Open Derby/Maturity Entry Form
Horse's Name			Reg. #
Year Foaled		Sex	Color
Sire			Dam
Owner Name			Rider Name
Address			Address
City/St/Zip			City/St/Zip
Phone			Phone
E-mail			E-mail

You may make copies of this form as needed: ONE entry per form. Please enclose copy (front and back) of horse’s registration papers with nomination fees. I agree, by entering the above named horse, to abide by the Cornhusker Futurity/Derby rules and regulations. Further, I agree to release the Custer Co. Fairgrounds and the Cornhusker Futurity/Derby staff from any claims of injury or loss.

Signature: ___________________________________________			Date: _____________________________________________

Futurity payment schedule: June 1 $100.00 to nominate 10 day grace period on 1st payment July 1 $ 75.00 to sustain Aug 1 $ 75.00 to sustain			Derby payment schedule: June 1 $ 50.00 to nominate 10 day grace period on 1st payment July 1 $ 50.00 to sustain Aug 1 $ 50.00 to sustain

Payoff for Futurity 30% to 1st go 30 % to 2nd go 40% to average			Payoff for Derby 30% to 1st go 30 % to 2nd go 40% to average