ENTRY FORM – District VI Horse Judging Workout Please complete and send with entry fees to:

Penn State Cooperative Extension

Registration due: May 3, 2010 c/o Lisa Jones
112 Pleasant Acres Rd
All contestants should bring a pencil and a notepad!
York, PA 17402
(717-840-7408)

* Please fill out a separate form for different divisions you wish to enter teams and/or individuals*

Division (circle one): Team: _____________________________________Coach: ______________________________

Jr. Youth Sr. Youth Address: _______________________________________________________________________
Town: _____________________________________ State/Zip: ____________________________
Jr. Beginner Sr. Beginner Phone: _______________________ Email: ____________________________________________

Team Name Age as of D.O.B Address

1/1/10 (Mo/Day/Yr)
1
1
1
1
2
2
2
2
3
3
3
3
Ind.
Ind.
Ind.
Ind.

ENTRY SUMMARY: Please make checks payable to

No. Fees Total CAPITAL REGION 4-H
$35 per youth team
$10 per individual TOTAL DUE: $ _________________