Regional Year-End Awards Nomination Form

Name:_________________________________________   ApHC#________________________________
Address:_______________________________________________________________________________
City, State, ZIP_________________________________________________________________________
Phone Number:_________________________________  E-Mail:________________________________
Name of Horse:_________________________________  Reg#:_____________________  Sex:  G   M   S
Sire:__________________________  Reg#:__________  Dam:_____________________  Reg#:________

Write the classes you are nomination for under the appropriate division.
                                Youth                                                                     Non-Pro                                             Halter & Performance
__________________________________    __________________________________    __________________________________
__________________________________    __________________________________    __________________________________
__________________________________    __________________________________    __________________________________
__________________________________    __________________________________    __________________________________
__________________________________    __________________________________    __________________________________
__________________________________    __________________________________    __________________________________
__________________________________    __________________________________    __________________________________
__________________________________    __________________________________    __________________________________
__________________________________    __________________________________    __________________________________
__________________________________    __________________________________    __________________________________

Total Youth Classes Nominated:                               ________  @  $5.00 per class =  ___________________
Total Non-Pro Classes Nominated:                           ________  @  $5.00 per class =  ___________________
Total Halter/Performance Classes Nominated:        ________  @  $5.00 per class =  ___________________

                                                                                                                                                                TOTAL DUE:    ___________________

Send Regional Show Nominations to:                Complete the following checklist before mailing:
Sandy Truntz                                                                _____ Class Nominations Completed
8496 Western Road                                                     _____ Registrations Papers Enclosed (front & back)
Cedarburg, WI  53012                                                 _____ Check #_________ for $_________ enclosed
                                                                                    _____ NEWApHC  Membership Paid:    Yes     No   

NOTE:  If you are not a member of NEWApHC, you need to complete a membership form and mail to:  Sandy Truntz, 8496 Western Rd, Cedarburg, WI  53012    (DUES: $20.00 Family / $15.00 Individual)
Office Use Only:  Date Received _________________

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