Racing Challenge Enrollment Form printable pdf download

Bank of America Racing Challenge Enrollment Form

FOR OVERNIGHT DELIVERY TO AQHA: 1600 QUARTER HORSE DR, AMARILLO, TX 79104 • MAILING ADDRESS: P.O. BOX 36200, AMARILLO, TX 79120

806 - 349-6402

EMAIL TO: •

✆

877-222-7223 •

FOR MORE INFORMATION CALL:

FAX:

BY DECEMBER 31

MAKE CHECKS PAYABLE TO: BANK OF AMERICA RACING CHALLENGE

The enrollment fee is based on the age of the horse at the time of enrollment. On or before December 31, the enrollment fees are as follows:

Weanlings

– $300 • Yearlings

– $600 • 2-year-olds

– $2,500,

(foals of 2016)

(foals of 2015)

(foals of 2014)

January 1 - March 15

• 2-year-olds

– $8,000,

• 3-year-olds & up – $20,000

(foals of 2014)

March 16 - December 31

AQHA REGISTRATION NUMBER

HORSE’S NAME

Foal Year ___________________ Gender ______________ Fee Paid __________________________

Sire’s Name ____________________________________________________________________________________________________________________________________________________

Dam’s Name ___________________________________________________________________________________________________________________________________________________

Make checks payable to “Bank of America Racing Challenge.” Nominator must be recorded owner or lessee at

ENROLLMENT INFORMATION AND FEE:

time of enrollment. Nomination awards will be paid based on this information as shown on AQHA records at time of enrollment

Name _________________________________________________________________________________________

AQHA ID#

Mailing and Street Address _________________________________________________________________________ City/State/Zip __________________________________________________

Daytime Phone __________________________________________________________________________________ Fax __________________________________________________________

Email Address __________________________________________________________________________________________________________________________________________________

Social Securtiy Number or Federal Tax ID Number of Nominator ___________________________________________________________________________________________________________

ALL HORSES ENROLLED MUST BE REGISTERED WITH AQHA, OR HAVE A REGISTRATION APPLICATION PENDING OR IN ACCOMPANIMENT WITH THIS ENROLLMENT FORM.

I hereby request that the above described horse be accepted as eligible for participation in the

AQHA, its officers, employees and representatives from any and all liability from negligence, injury

American Quarter Horse Association’s Racing Challenge, and agree to be bound by all rules and

or otherwise, whenever or however arising, by virtue of my participation, including but not limited

conditions of the program, together with amendments thereto, and AQHA’s decisions regarding the

to all claims for personal injury or property damage sustained by me and/or my representatives and

program’s implementation. By filing this enrollment form, I agree to abide by and be bound by the rules

employees, including jockeys, from whose claims, I additionally agree to indemnify AQHA, its officers,

and regulations set forth in the current AQHA Official Handbook, or as it may later be amended, and

employees and representatives. I acknowledge that this horse or horses will be racing under pari-

further agree that AQHA’s Executive Committee shall be the final arbitrator of all matters pertaining

mutuel authority separate from AQHA; that AQHA maintains no control in the implementation or running

to the Racing Challenge. In consideration of being allowed to participate in the Racing Challenge,

of this race; and has disclaimed duty or responsibility for the safety of participants.

I assume all risks pertaining to such participation, agreeing to release, discharge, and indemnify

●

IF PAYING BY CREDIT CARD, PLEASE COMPLETE THE FOLLOWING:

CHECK

MONEY ORDER

AMERICAN EXPRESS

MASTERCARD

VISA

CARD NUMBER

EXP. DATE (MMYY)

DAYTIME PHONE

CARDHOLDER NAME

CARDHOLDER SIGNATURE

BILLING ZIP CODE

DO NOT SEND CASH • U.S. FUNDS ONLY

Racing Challenge Enrollment Form

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