Entry Confirmation - Please review the following information

Horse Information
Name:	Hot Cabin Black Jack	Height:		Birth Country:
Breed:	Paint	Sire:		Year of Birth:
Sex:	Gelding	Dam:		Breeder:
Color:	Black	Dams Sire:		Passport #:

Information	Horse	Rider	Owner	Trainer	Coach
Name:		Melodye Augusti	Melodye Augusti	Melodye Augusti
Address:		19 Crystal Drive	19 Crystal Drive	19 Crystal Drive
City/St/Zip:		Hampton Falls, NH 03844	Hampton Falls, NH 03844	Hampton Falls, NH 03844
Country:		USA	USA	USA
Telephone:		8579723038	8579723038	8579723038
E-mail:		printcessme@aolcom	printcessme@aolcom	printcessme@aolcom
Citizenship:
Rider Status:
Need Safe Sport:		No	No	No
Need Signature:		No	No	No	No
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
8	Sunday	USDF Intro Level, Test B	USDF Introductory Level, Test B 2023	No	No	$ 30.00

Stable Fees	Rate	Quantity	Amount

Other Fees	Rate	Quantity	Amount
Processing Fee	$ 20.00	1	$ 20.00

Payments	Amount
Check	$ 80.00

Class Total	Stable Fees	Other Fees	Total Fees	Payments	Amount Due
$ 60.00	$ 0.00	$ 20.00	$ 80.00	$ 80.00	$ 0.00

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

User	Date / Time	Notes
Secretary	5/31/2023 5:59:51 AM	UPLOADED:

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