Entry Confirmation - Please review the following information

Horse Information
Name:	POETRY IN MOTION	Height:	17.1	Birth Country:
Breed:	AMERICAN WARMBLOOD	Sire:	NEW YORK CAT	Year of Birth:	2009
Sex:	Mare	Dam:	POETIC LICENSE	Breeder:
Color:	CHESTNUT	Dams Sire:		Passport #:

Information	Horse	Rider	Owner	Trainer	Coach
Name:		CASSIDY LEBLANC	ISABELLA SAFRAN	DAWN BRUNEAU	DAWN BRUNEAU
Address:		15 Otterson Rd	21 Oakland Ave	305 Salem St	305 Salem St
City/St/Zip:		LONDONDERRY, NH 03053-2856	SAUGUS, MA 01906-3229	BRADFORD, MA 01835-7622	BRADFORD, MA 01835-7622
Country:		usa	usa	usa	usa
Telephone:		781-727-5148	617-840-9544	978-476-6858	978-476-6858
E-mail:		lindajleblanc66@gmail.com	Minniemama@ymail.com	bruneaudawn@gmail.com	bruneaudawn@gmail.com
Citizenship:		usa
Rider Status:		JR/YR
	5839463	5852474	5811499	5398840	5398840
			239833	205249	205249
Need Safe Sport:		No	No	No	No
Need Signature:		Yes	Yes	Yes	Yes
Need Coggins:	No
Need Vaccines:	No
Need Parent Signature:				No
StallGroup:

Need List

Class	Day	Class Name	Test Name	Qual/Div	Need FS Doc	Amount
7	Sunday	USDF Intro Level, Test A	USDF Introductory Level, Test A 2023	No	No	$ 30.00

Stable Fees	Rate	Quantity	Amount

Other Fees	Rate	Quantity	Amount
Non-Member Fee (per class)	$ 15.00	1	$ 15.00
Processing Fee	$ 20.00	1	$ 20.00

Payments	Amount
Paypal	$ 65.00

Class Total	Stable Fees	Other Fees	Total Fees	Payments	Amount Due
$ 30.00	$ 0.00	$ 35.00	$ 65.00	$ 65.00	$ 0.00

Memo
Complete entries must include NHDEA waiver and 12-month coggins!

User	Date / Time	Notes
Secretary	5/31/2023 5:59:45 AM	UPLOADED: Must submit NHDEA liability form
Secretary	5/31/2023 7:05:08 AM	UPLOADED: Must submit NHDEA liability form
Entrant	5/31/2023 7:06:37 AM	ACCEPTED: I will bring the signed NHDEA liability form on Sunday - if that is ok

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