2009 South Carolina NBHA State Championships
$7,500 Added
Entry Form (One rider per form)
Hippodrome Arena, North Augusta – August 7-9, 2009

Name:
Address:
City: State: Zip:
NBHA #: Expiration Date:
Telephone Number: ( )
E-mail:
SC NBHA barrel races attended, list dates: _________, __________, __________ You must have attended 3 SC NBHA Shows since the 2008 SC State Show.
Entry Deadline is July 29, 2009, NO REFUNDS (Postmark date) There is a $20.00 late fee - 1 time per rider.
YOUTH 4D - $1,250 Added $50.00 Per Entry	SENIOR 4D - $1,250 Added $50.00 Per Entry
Horse ___________________________	Horse ___________________________
Horse ___________________________	Horse ___________________________
Horse ___________________________	Horse ___________________________
OPEN 4D - $5,000 Added $75.00 per entry
Horse ___________________________	Horse ___________________________
Horse ___________________________	Horse ___________________________
Total $ OPEN _________ + $ YOUTH _________ + $ SENIOR _________
$___________ = Total entries
$5.00 Insurance Fee. (To cover $1,000,000 facility required insurance policy)
$25.00 Awards Sponsorship Fee. If already submitted, please ignore.
$___________ = Stalls w/3 bags shavings _____ @ $75.00 each
$___________ = TOTAL CHARGES
Send entry to: SC NBHA State Championships C/O Ryan Dohrn * 2551 Atomic Rd. * Beech Island, SC 29842 * (803)867-9100
I, the undersigned, do hereby agree to all the rules and regulations set forth by the SC NBHA. I hereby agree that I will not hold the SC state show personnel, NBHA, or the Hippodrome Arena responsible for theft, accident or injury that could occur during this event. _______________________________________________________________________________ Signature (Parent/Guardian of minor). No entries will be accepted that are not completed and signed. No exceptions.