Entry Confirmation - Please review the following information

Horse Information
Name:	Ibericos Empire	Height:	17.1	Birth Country:
Breed:		Sire:		Year of Birth:	2000
Sex:	Gelding	Dam:		Breeder:
Color:	Bay	Dams Sire:		Passport #:

Information	Horse	Rider	Owner	Trainer	Coach
Name:		Kelsey Walsh	Constance Bernhardt	DAWN FRAZER
Address:		1 Yvonne Dr	74 Oak Hill Street	1 Yvonne Drive
City/St/Zip:		Pepperell, MA 01463	Pepperell, MA 01463	PEPPERELL, MA 01463-1743
Country:		usa	usa	usa
Telephone:		9788554234	978-433-9812	978-727-6750
E-mail:		takeachance0013@gmail.com	cjbernhardt@gmai.com	dawnfrazer@charter.net
Citizenship:		usa
Rider Status:
				4014438
				51010
Need Safe Sport:		No	No	No
Need Signature:		Yes	Yes	Yes	No
Need Coggins:	Yes
Need Vaccines:	No
Need Parent Signature:				No
StallGroup:

Need List

Class	Day	Class Name	Test Name	Qual/Div	Need FS Doc	Amount
11	Sunday	USEF Training Level, Test 1	USEF Training Level, Test 1 2023	No	No	$ 30.00
12	Sunday	USEF Training Level, Test 2	USEF Training Level, Test 2 2023	No	No	$ 30.00

Stable Fees	Rate	Quantity	Amount

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

Payments	Amount
Paypal	$ 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 5:59:48 AM	UPLOADED: Must submit NHDEA liability form
Entrant	5/31/2023 11:42:40 AM	ACCEPTED:

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