NMRHA Derby

NMRHA Derby 3, 4 & 5 Year Old Nomination Form

Derby babies pay only the $50 Office Tracking Fee.

Owners Name: __________________________________________email:_________________________________

Address: ____________________________________________________________________________________

City/State/Zip: ___________________________________________________ phone:_______________________

Entry Name: ______________________________________________________ Reg. #______________________

Sire: ____________________________________________________________ Reg. # ______________________

Dam: ____________________________________________________________Reg. # ______________________

Nomination fee is $300 for the Open Division and $200 for the Non Pro Division to be paid by May 31 in their competition year.

Late entries are accepted according to schedule below.

Nomination Fees

If paid by May 31

If paid by July 1

If paid by Sept 1

If paid by September 15

Open

$300

$300 + $50

$300 + $100

$300 + $150

Non Pro

$200

$200 + $50

$200 + $100

$200 + $150

Stallion Owners Who Have Donated a Breeding To This Year’s Derby That Was Sold Use This Form

You may enter one division at half the nomination fee (does not include penalties).

Stallions name:________________________________

Date: ________________________________________

Open Division Nomination Fees Enclosed: $______

Non Pro Div. Nomination Fees Enclosed: $______

Tracking Office Fee $ $50

Total Fees Enclosed: $_______

Regular Entrants & Sire & Dam Offspring Entrants Use This Form

Date: ___________________________

Open Division Nomination

Fees Enclosed: $____________

Non Pro Div. Nomination

Fees Enclosed: $____________

Tracking Office Fee $ ___50_____

Total Fees Enclosed: $____________

Please make out check to: NMRHA Derby . Mail with this form to: Travis Filipek, 883 Tipperary Rd, Oregon, WI 53575

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