Event Entry
  
* Indicates required field (Other fields will be required based on Classes selected.)
 *Event

   Horse

 Sex

 Year Foaled

Horse Papers MUST be faxed or Mailed to the NCHA office, before entry is valid.

Registration No

  Sire  

Rider

NCHA #

Rider DOB

  Month Day Year

Rider Email


*Make premium checks payable to: *S.S. or Corp ID #


*Owner   *NCHA #
*Address
*City

*State

*Zip Code *Country
*Phone  

*Email

*Re-Enter Email

Above email address will be used to send entry confirmation.

Correspondent   NCHA #
Address
City

State

Zip Code Country
Phone  

Email


*** FEE RECEIVED AFTER GRACE PERIOD IS SUBJECT TO A PENALTY FEE. ***
  Fee is due On or Before Fee
Class Oct 15
Paid in Full
Oct 15 Jan 1 May 1 July 1 Aug 1 Sept 1 Oct 1 After Draw
Open...................................... $2,385* $100 $200 $200 $500   $500 $1,135* $12,635*
John Deere Div of the Open               $500 $750
Open Senior.....................               $500 $750
Non-Professional................... $2,000* $100 $100 $100 $400   $400 $1,110* $10,610*

Non-Professional Senior.....

              $500 $750

Non-Pro/Lmt Non-Pro Comb

              $920* $1,370*
Limited Non-Professional...           $500   $955* $7,055*

Limited Non-Pro Senior......

              $500 $750
Amateur................................           $500   $805* $6,305*

Amateur Senior................

              $500 $750

Am/Unlimited Am Comb....

              $520* $770*
Unlimited Amateur.................           $500   $805* $6,305*

Unlimited Am Senior.........

              $500 $750
*** FEE RECEIVED AFTER GRACE PERIOD IS SUBJECT TO A PENALTY FEE. ***

* Includes a $25 cattle surcharge, $10 Drug Fee and voluntary PAC Fee.
(PAC Fee = $100 for Open, $75 for Non-Pro, $20 for Limited Non-Pro, $20 for Amateur & $20 for Unlimited Amateur)
Funding the PAC is important to be able to maintain state funding at the NCHA Triple Crown.
Select this option to opt out of PAC Fee.  Additional PAC Fee Contribution

* Name on Credit Card
* Payment   * Card #
* Expiration Date: MM
YY   * Security Code

Electronic Signature: Yes No
If "YES" is not selected then this entry form will not be accepted.
 

 
Clicking Submit button more than once could result in your Credit Card being charged more than once.
 

Signature (if form printed and mailed to NCHA): _____________________________________

Copyright ©National Cutting Horse Association All rights reserved. · Information in this document is subject to change without notice. v:2013