BOSEN ALL BREED RACE DERBY

BOSEN $5,000 ADDED ALL BREED RACE DERBY ENTRY FORM
1158 North State Street
Preston, Idaho 83263-5377
(print this page)

INSTRUCTIONS:

Submit this Secure Entry Form on or before January 20, 2008
OR
Enter the information below without submitting the form, print, sign and mail the form on or before January 15, 2008.
Send a copy of registration papers for each nominated horse to:

BOSEN $5,000 ADDED ALL BREED RACE DERBY
1158 North State Street
Preston, Idaho 83263-5377
Send payment to the above address
OR
Submit your payment online with your credit card. The online payment option is also available for your convenience in making Futurity Sustaining and Late Fee payments.

HORSE’S NAME:

REGISTRATION #:

HORSE’S FOALING DATE:

HORSE’S SIRE AND BREED:

HORSE’S DAM AND BREED:

• NOMINATING FEE:	$200 POSTMARKED ON OR BEFORE JANUARY 20
• SUSTAINING FEE:	$100 POSTMARKED ON OR BEFORE FEBRUARY 1
• SUSTAINING FEE:	$100 POSTMARKED ON OR BEFORE MARCH 1
• SUSTAINING FEE:	$100 POSTMARKED ON OR BEFORE APRIL 1
• SUSTAINING FEE:	$100 POSTMARKED ON OR BEFORE MAY 1
• SUSTAINING FEE:	$100 POSTMARKED ON OR BEFORE JUNE 1
• SUSTAINING FEE:	$100 POSTMARKED ON OR BEFORE JULY 1
• SUSTAINING FEE:	$100 POSTMARKED ON OR BEFORE AUGUST 1
• SUSTAINING FEE:	$100 POSTMARKED ON OR BEFORE SEPTEMBER 1
• LATE FEE:	$2500 POSTMARKED AFTER SEPTEMBER 1

OWNERS NAME:
ADDRESS:
CITY:
STATE:
ZIP:
PHONE:
EMAIL:
TRAINER’S NAME:

By clicking the Submit Button, I agree to abide by all rules and conditions set forth for the Bosen $5,000 Added All Breed Race Derby. The undersigned agrees to abide by all rules and conditions set forth for the Bosen $5,000 Added All Breed Race Derby (only applicable if printing this form and mailing it). Signature of Owner or Agent:________________________________________________