Midwest Gold Challenge Nomination Form

MIDWEST GOLD CHALLENGE NOMINATION FORM

Date:____________

Name of Horse:_________________________________

PHBA No. ___________________

Exhibitor:_____________________________________

PHBA No.__________(check) Open__ Youth__ Am___

Address:______________________________________

City/State/Zip:_________________________________

Phone:________________________________________

Award Areas

AWARD AREAS: (Please check each award area in which you wish to nominate)

(One form per horse or horse / rider combo)

____ Yearling Longeline      ____ Halter Mares Open

____ Youth 5-9             ____ Halter Mares Amateur

____ Youth 10-13            ____ Halter Geldings Open

____ Youth 14-18            ____ Halter Geldings Amateur

____ Amateur Performance   ____ Halter Stallions Open

____ Amateur Select Performance ____ Halter Stallions Amateur

____ Jr Performance Horse     ____ Open Color

____ Sr Performance Horse      ____ Amateur Color

____ Contesting/Gaming Horse _____ Novice Amateur Performance

Nomination Fee Totals

Nomination Fees:

p Youth/Amateur $10.00 per horse/per exhibitor/ per award area

p Open $10.00 per horse / per award area

# Award Areas ______ X $10.00 = _________

Signature:________________________

Make Checks Payable to: Midwest Gold Challenge

Your points do not begin until you have a PAID nomination prior to entering the first day of the show. You cannot add the nomination to your show tabs. Must have a separate check to Midwest Gold Challenge.

Mail Completed form and check to : Phil & Chris Madden, 59 Hidden River Court, Tipton, Iowa 52772