Gold Dust ranch Rodeo Fund Raiser Jim haswell gold

							                                      Gold Dust ranch Rodeo Fund Raiser
                                        Jim haswell gold dust Arena
                                              june 19th Play day
                                                 Entry Form



Name: ____________________________________________________


Address: ___________________________________ City: _______________________ST: ___________ Zip: ________


PH#: (_____) ________-______________                                           E-Mail: _______________________________________


                                                   Age Group (as of Jan 1st this year)

           7 & Under                   8-11                          12-15                         16-40                    Over 40

  Games $3.00 per event or $20.00 all day                     No Refunds                   1st event after barrel races runs until dusk

1. Barrels                                                                                          5. Key Hole

2. Speed Barrels                                                                                    6. Half Eight

3. Flag Race                                                                                        7. Polo Turn

4. Poles                                                                                            8. Spur Race



Number of entries_____________ x $3.00 / $20.00 for all events                                                              $____________

Arena Fee: Charge per Rider (Unlimited Horses)                                                                              $3.00________



                                       NO REFUNDS                                                  Events Total             $____________

 I agree to hold harmless Idaho City, Bill Stirling & Company, Gold Dust Rodeo, Stock                               Check #____________
 Contractor(s), Lions International, NBHA, any officials, directors, vendors, organizations,
 agents, volunteers, spectators or others from liability or damages that might occur as a result
 of my participation in these events.                                                                               Cash $_____________

 Signed ____________________________________________Date_______________________                                     Rcvd by ____________

                                                                                                                       Contact Information:
 Parent or Guardian of Minor Signature______________________________________________
                                                                                                                    NBHA Beverly Williams
                                                                                                                           (208) 890-3788
 Printed name of Parent or Guardian _______________________________________________                                 www.golddustrodeo.com
                                                                                                                              Jim McClure
                                                                                                                           (208) 891-1405