Derby LAE Entry Form 2023

Derby LAE Entry Form - Cascades Futurity 2023

One (1) entry form per horse, please.

Owner Name*

First Name

Last Name

Rider Name*

Owner NCHA #

Rider NCHA #

Phone*

Email*

Horse Registered Name*

Horse Registration Association and Reg #

Upload Horse Registration Papers

No File Chosen

File uploads may not work on some mobile devices.

Open Derby Class Entry Options

OPEN Derby

Open Derby Class - $30,000 Added

$ 1,940.00

Quantity:

Open Derby - GELDING (Class Within)

Open Derby - Gelding Class Within

$ 275.00

Quantity:

Open Derby - Chrome Cash (Class Within)

Open Derby CHROME CASH (Class Within) - Must be dual registered with APHA to be eligible.

$ 275.00

Quantity:

Open Intermediate Derby

Open Intermediate Derby Class - $5,000 Added. (NCHA Rider LTE $0 - $199,999)

$ 1,150.00

Quantity:

Open Intermediate Derby - GELDING (Class Within)

Open Derby - Gelding Class Within

$ 275.00

Quantity:

Open & IM Open Derby COMBO

Open & IM Open Derby COMBO - $30,000 Added Open Derby & $5,000 Added IM Open Derby - combo runs. (Combo discount $250)

$ 2,840.00

Quantity:

Open & IM Open Derby - GELDING (Class Within)

Gelding Class Within COMBO

$ 550.00

Quantity:

Non-Pro Derby Class Entry Options

NON-PRO Derby

Non-Pro Derby Class - $7,500 Added

$ 1,150.00

Quantity:

Non-Pro Derby - GELDING (Class Within)

Non-Pro Derby - Gelding Class Within

$ 275.00

Quantity:

Non-Pro Derby - SENIOR (Class Within)

Non-Pro Derby - Senior Class Within

$ 275.00

Quantity:

Non-Pro Intermediate Derby

Non-Pro Intermediate Derby Class - $3,500 Added. (NCHA Rider LTE $0 - $99,999)

$ 1,000.00

Quantity:

Non-Pro IM Derby - GELDING (Class Within)

Non-Pro Derby - Gelding Class Within

$ 275.00

Quantity:

Non-Pro IM Derby - SENIOR (Class Within)

Non-Pro Derby - Senior Class Within

$ 275.00

Quantity:

Amateur Derby Class Entry Options

Amateur Derby

Amateur Derby Class - $5,000 Added

$ 1,050.00

Quantity:

Amateur Derby - GELDING (Class Within)

Amateur Derby - Gelding Class Within

$ 275.00

Quantity:

Amateur Derby - SENIOR (Class Within)

Amateur Derby - Senior Class Within

$ 275.00

Quantity:

Amateur Intermediate Derby

Amateur Intermediate Derby Class - $3,000 Added. (NCHA Rider LTE $0 - $49,999)

$ 925.00

Quantity:

Amateur IM Derby - GELDING (Class Within)

Amateur Derby - Gelding Class Within

$ 275.00

Quantity:

Amateur IM Derby - SENIOR (Class Within)

Amateur Derby - Gelding Class Within

$ 275.00

Quantity:

TB Fee

Turn Back Stall Fee *

**Mandatory - 1 per show horse. Helps provide free stalls to turn back horses.

Payment Selection (Please select an option)

I plan to pay by:*

Entry Fee Total to Pay at Show $

Please mail checks to:

CASCADES FUTURITY
c/o Theresa Nelson
16847 Ponderosa Cascade Dr
Bend, OR 97703

***PLEASE DO NOT MAIL CHECKS AFTER AUGUST 30TH

***NOTE: Entry Checks MUST be received prior to the Draw