Entry Confirmation - Please review the following information

Horse Information
Name:	Egobuster	Height:	16.2	Birth Country:
Breed:	thoroughbred	Sire:		Year of Birth:	2017
Sex:	Mare	Dam:		Breeder:
Color:	Bay	Dams Sire:		Passport #:

Information	Horse	Rider	Owner	Trainer	Coach
Name:		Madilyn Hemp	Barbara Paquette	Crystal Little	Crystal Little
Address:		15 Maple Ridge Rd	48 Range Road	62 Meditation Ln.	62 Meditation Ln.
City/St/Zip:		Methuen, MA 01844	windham, NH 03087	Atkinson, NH 03811	Atkinson, NH 03811
Country:		usa	usa	usa	usa
Telephone:		9783143889	6033277072	603-953-4243	603-953-4243
E-mail:		madilyn.hemp@gmail.com	barbara-paquette@hotmail.com	derbytalk@yahoo.com	derbytalk@yahoo.com
Citizenship:		usa
Rider Status:		JR/YR
		5798113		4887551	4887551
				130908	130908
Need Safe Sport:		No	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
12	Sunday	USEF Training Level, Test 2	USEF Training Level, Test 2 2023	No	No	$ 30.00
13	Sunday	Maiden USEF Training Level, Test 3	USEF Training Level, Test 3 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	$ 95.00

Class Total	Stable Fees	Other Fees	Total Fees	Payments	Amount Due
$ 60.00	$ 0.00	$ 35.00	$ 95.00	$ 95.00	$ 0.00

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

User	Date / Time	Notes
Secretary	5/31/2023 5:59:46 AM	UPLOADED:
Entrant	5/31/2023 6:01:46 AM	ACCEPTED:

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