Entry Confirmation - Please review the following information

Horse Information
Name:	Magnum	Height:	15.1	Birth Country:
Breed:	Appaloosa	Sire:		Year of Birth:	2007
Sex:	Gelding	Dam:		Breeder:
Color:	Chestnut w/Blanket	Dams Sire:		Passport #:

Information	Horse	Rider	Owner	Trainer	Coach
Name:		Lisa Fraser	Lisa Fraser	Crystal Little	Crystal Little
Address:		2 Bartlett Rd	2 Bartlett Rd	62 Meditation Ln.	62 Meditation Ln.
City/St/Zip:		Derry, NH 03038	Derry, NH 03038	Atkinson, NH 03811	Atkinson, NH 03811
Country:		usa	usa	usa	usa
Telephone:		8609615319	8609615319	603-953-4243	603-953-4243
E-mail:		lisa.fraser11@gmail.com	lisa.fraser11@gmail.com	derbytalk@yahoo.com	derbytalk@yahoo.com
Citizenship:		usa	usa
Rider Status:		Adult Amateur
	5852845	5852647	5852647	4887551	4887551
	1158576	242882	242882	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
14	Sunday	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	$ 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 5:59:46 AM	UPLOADED:
Entrant	5/31/2023 6:02:15 AM	ACCEPTED:

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