PEI HARNESS RACING INDUSTRY ASSOCIATION

$250 BREEDERS AWARD FOALS OF 2020

Date of Application: _______________________________

Name of Applicant: _______________________________

Full Mailing Address: _____________________________________________

______________________________________________

Cell Phone Number: ______________________________________________

Foal Name Registration Number Dam Name

CERTIFICATION

I, _____________________________ certify as follows concerning the above foal(s)

(Name of Owner or Representative)

Foaled on Prince Edward Island, and

Dam Resided on Prince Edward Island for at Least 183 days in the Foaling Year

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Signature