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Pre Entry Form $Checks will be accepted for PRE-Entrys only. It will be cash only the day of the race. Please make checks payable to Miranda Sparks/Relay for Life.$ Mail to Relay for Life c/o Miranda Sparks Rt. 1 Box 8825 Antlers, OK 74523 Fourth Annual Relay for Life April 17, 2011 (Please complete one for per person) Name:________________________ Address:_________________________________________ City/State/Zip:_________________________________________ 1) Horse Name: ______________________________________ Exhibition Barrels: _________ x $ 4.00 = $_________ or 3 for $10.00 Open Barrels : _________ x $30.00 = $_________ Senior Incentive:________ x $20.00 = $________ Youth Incentive(15 & under):________ x $10.00 = $________ Pink Incentive(Must run in a Pink Shirt):_______ x $20.00 = $______ 2) Horse Name: ______________________________________ Exhibition Barrels: _________ x $ 4.00 = $_________ or 3 for $10.00 Open Barrels : _________ x $30.00 = $_________ Senior Incentive:________ x $20.00 = $________ Youth Incentive(15 & under):________ x $10.00 = $________ Pink Incentive(Must run in a Pink Shirt):_______ x $20.00 = $______ 3) Horse Name: ______________________________________ Exhibition Barrels: _________ x $ 4.00 = $_________ or 3 for $10.00 Open Barrels : _________ x $30.00 = $_________ Senior Incentive:________ x $20.00 = $________ Youth Incentive(15 & under):________ x $10.00 = $________ Pink Incentive(Must run in a Pink Shirt):_______ x $20.00 = $______
Late Fee if not post marked by April 8, 2011 (One Per Person)____ = $10.00 TOTAL FEES $_________ Pursuant to the Oklahoma Livestock Activities Liability Limitation Act (Title 76 Oklahoma Statutes ยง50.1-15.4), I will not hold Relay for Life, the facility owner, or any event staff or sponsors responsible for any damage or injury to myself, my family, my equipment, or any of my livestock while driving to or from or participating at this Relay for Life event. I further certify that I have available at the request of event management, a current NEGATIVE EIA TEST CHART on each animal I have on the event grounds. I understand that if State and Local Authorities require presentation of said test chart at this event and I cannot present a NEGATIVE EIA TEST CHART per any one (1) animal, I will be responsible for any fines personally, and will be responsible for reimbursement of any fines to the event producer. YOUR SIGNATURE CONSTITUTES A RELEASE OF LIABILITY __________________________________ __________ Signature of Contestant or Contestants Legal Guardian (if minor) Date |
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