Sample Breakaway Jackpot – SALTY DIGITAL SERVICES

Entry Form - Gould Roping Horses Jackpot Sunday April 30

Thank you to our sponsors Brad McDaniel- Hardeman County Farm Bureau Insurance., Daniel Bishop Horseshoeing, Berkshire Hathaway Home Services McLemore & Co Realty, Chapultepec Mexican Restaurant, Snappin' Turtle Leatherworks, Salty Digital Services, Prestige Baths, and Breakaway Betty apparel. Sunday April 30th at Gould Arena (1985 Poole Rd. Moscow, TN 38057) Training runs can be purchased onsite for $15 a run. Open to start at 2:00 PM. Followed by the beginner/youth 2 HD jackpot and then the Redemption Roping.

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Entry ID

Rider Information

Name*

First Last

Rider Physical Address*

Street Address Address Line 2 City State ZIP Code

If you leave prior to event payout, we will mail you your winnings, but we will not ship awards, they must be picked up onsite.

Contact Info

Email*

Phone*

ENTRIES

Only accepting Pre-entries for Open and Beginner, no walk ups unless entering Redemption roping. Pre-Entries Close Thursday April 27th at midnight. Can enter up to 2x in the open, 3 head average (Average combines A runs, or B runs to calculate average winner, EX: Can't take fastest A run and fastest B run to combine for average.) $120 ENTRY (Added $ TBD), Prizes for fast time each go, Draw will be posted a few days prior, Electric eye barrier. Beginner roping will be a 2 head, (LESS THAN $500 WON BREAKAWAY ROPING OR, under 14 years old) Can enter up to 2x, $85 ENTRY. $10 office fee per rider - $15 exhibition runs available onsite - and 4% credit card processing fee, non refundable.

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Horse 1

Price:

Horse 2

Price:

Horse 3

Price:

Horse 4

Price:

Horse 5

Price:

Entry Details

How many horses do you want to enter on this form?*

Horse 1 Entry Details

Horse #1 Name

Entries Horse 1

Horse 2 Entry Details

Horse #2 Name

Entries Horse 2

Horse 3 Entry Details

Horse #3 Name

Entries Horse 3

Horse 4 Entry Details

Horse #4 Name

Entries Horse 4

Horse 5 Entry Details

Horse #5 Name

Entries Horse 5

Any special requests? Notes to the producer?

Office Fee

Price:

Subtotal

$0.00

Pay Onsite Total

Credit card fees (4%)

$0.00

Coupon

Total

PLEASE NOTE: CREDIT CARD FEES ARE NOT REFUNDABLE.

Select Payment Method*

Pay Onsite (Cash Only)

Pay Now via Credit Card

Under Tennessee law, an equine activity sponsor is not liable for an injury to, or the death of, a participant in equine activities resulting from the inherent risk of equine activities. I understand that every effort will be made to ensure the safety of each contestant and his/her horse(s). I hereby release the producer, the staff, the arena, and all sponsors involved. I also acknowledge that I have read, understand, and agree to abide by any ground rules enforced for specific events.

Liability Release*

I have read and agreed to the release of liability.

Credit Card

Card Details

Cardholder Name

CREDIT CARD BILLING ADDRESS*

Street Address Address Line 2 City State ZIP Code

The info above must match the billing info for the card you will be paying with!

Please check your email for entry confirmation! If you do not receive an email receipt, we may not have your entry! Please also review your confirmation for any errors or omissions. If you feel there is an error, or you didn't receive your email confirmation within 24 hrs, please reach out to SaraBeth, 901-603-0321.

Thank you for your entry!

Phone

This field is for validation purposes and should be left unchanged.