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Super Stakes Entry Form

Horse Search *Search by Name or #

Horse

Sex

Year Foaled *Required

Horse Nominated? *Required

Registration #

Sire

If the horse you are entering is not found by searching, please submit a photocopy of registration certificate or colored application to Cari Claxton (cclaxton@nchacutting.com) in office by Feb 15

Premium Checks Pay To *Required

Owner Search *Search by Name or #

Owner is inactive. Contact NCHA Membership to renew.

Owner Name *Required

New Member?

Owner NCHA # *Required

Subscribe me to text updates?

Address *Required

Address 2

City *Required

Country *Required

State *Required

Zip/Postal Code *Required

Owner Phone # *Required

Owner Email *Required

Re-Enter Email *Required

All other information is on file

Correspondent Search *Search by Name or #

Correspondent Name

Correspondent NCHA #

Correspondent Phone #

Correspondent Email

Address

Address 2

City

Country

State

Zip/Postal Code

All other information is on file

INDICATE ENTRY TYPE AND PAYMENT IN THIS SECTION

Division

Payments

Senior

Gelding

Chrome Cash

Novice

Total

OPEN

Rider Search Name or #

Rider #:

OPEN
$3,250.00* TOTAL

1. Jan 17	2. Feb 15
$2,175.00	$2,650.00*

$600.00

INT OPEN

+Eligible Riders will be automatically entered
into the intermediate for no additional fee.
Sub-classes must be entered separately.

$600.00

LTD OPEN
$1,450.00* TOTAL

1. Jan 17	2. Feb 15
$900.00	$1,225.00*

$600.00

NONPRO

Rider Search Name or #

Rider #:

NONPRO
$3,000.00* TOTAL

1. Jan 17	2. Feb 15
$1,875.00	$2,587.50*

$600.00

INT NONPRO

+Eligible Riders will be automatically entered
into the intermediate for no additional fee.
Sub-classes must be entered separately.

$600.00

LTD NONPRO
$1,425.00* TOTAL

1. Jan 17	2. Feb 15
$900.00	$1,200.00*

$600.00

AMATEUR

Rider Search Name or #

Rider #:

AMATEUR
$1,655.00* TOTAL

1. Jan 17	2. Feb 15
$975.00	$1,497.50*

$600.00

INT AMATEUR
$1,445.00* TOTAL

1. Jan 17	2. Feb 15
$817.50	$1,340.00*

$600.00

LTD AMATEUR
$1,050.00* TOTAL

1. Jan 17	2. Feb 15
$517.50	$1,047.50*

$600.00

AM-INT-LTD
$2,850.00* TOTAL

1. Jan 17	2. Feb 15
$1,800.00	$2,465.00*

AM-INT
$2,450.00* TOTAL

1. Jan 17	2. Feb 15
$1,500.00	$2,165.00*

AM-LTD
$2,055.00* TOTAL

1. Jan 17	2. Feb 15
$1,267.50	$1,805.00*

INT-LTD (A)
$1,845.00* TOTAL

1. Jan 17	2. Feb 15
$1,117.50	$1,640.00*

Grand Total:

Late Entries in all Events requires a penalty. Entries not accepted without payment.

* Includes voluntary PAC fee. Under Texas Election Code, Chapter 253, the Political Action Committee (PAC) fee is a voluntary contribution. Funding the PAC is important to be able to maintain state funding at the NCHA Triple Crown events. Your contribution will provide critical assistance to the NCHA with this effort.

Help support the PAC by making an additional contribution

The voluntary PAC fee is included in this payment. To opt out of the PAC fee, check the box below.
Please opt this entry out of the voluntary PAC fee (Open $100 / Np $75 / Am $20)

RELEASE FROM LIABILITY AND WAIVER OF RESPONSIBILITY: As a condition to participate in this event, the NCHA, the directors, officers, employees, members, agents and representatives are hereby released from all claims, demands, or causes of action of any kind or nature whatsoever; whether now existing or to hereafter accrue, on account of any damage, cost or expense (I) As a result of any bodily injury, loss or damage to any animals, equipment or other personal property, from any cause whatsoever including, but not limited to, the sole or concurrent negligence of NCHA, its directors, officers, employees, agents or representatives; or (ii) as a result of the interpretation or enforcement of the NCHA constitution, bylaws, rules or regulations and the risk of any such damage, cost or expense which may occur by reason of forgoing is hereby assumed and accepted. This waiver is binding on the undersigned as well as all riders, grooms and other helpers associated with the participation of the horse (s) described herein in this event and the undersigned indemnifies the NCHA from all claims, demands, or causes of action based on any of the foregoing. Both owner and rider of any horse entered in an NCHA produced event, by said entry, consents to the implementation of any action allowed by Standing Rule 35.a, Zero Tolerance by either show management or judge.

Electronic Signature *Required
I have read and agree to the above statement as well as the rules, terms and conditions included in the show rules published on nchacutting.com