Foal Nomination Form
to compete in the 2005 Futurity
Foals Born In 2003
Deadline: April 1, 2004

Use this form to nominate horses born in 2003 that you would like to have compete in the Peruvian Futurity. The sire of your nominee must be a Futurity nominated sire. The total cost that you will have in nominating fees by the time your horse competes for Futurity points is $300, payable over a three year period at $100 per year.
Please complete the following form, print and mail this form with all fees to:
Peruvian Futurity, 3095 Burleson-Retta Rd., Burleson, TX 76028   Tel.# 817-447-2703
This form must be postmarked on or before April 1, 2004 (or late fees apply, see below)

Your Name: Ranch Name:

Address: Email:

City, State, Zip: Telephone:

I wish to Nominate the following Horses to compete in Futurity 2005: Check S M or G to indicate sex of horse.

Horse #1: Name: S M G   PPHRNA# AAOBPPH#

Birthdate: Sire:    PPHRNA# AAOBPPH#

Name of Dam:     PPHRNA# AAOBPPH#

Horse #2: Name: S M G   PPHRNA# AAOBPPH#

Birthdate: Sire:    PPHRNA# AAOBPPH#

Name of Dam:     PPHRNA# AAOBPPH#

Horse #3: Name: S M G   PPHRNA# AAOBPPH#

Birthdate: Sire:    PPHRNA# AAOBPPH#

Name of Dam:     PPHRNA# AAOBPPH#

TOTAL Horse Nominating Fees ($100 each): $

(if your nomination is postmarked between April 2 - May 1 = $250; May 2 - June 1 = $300.   If your horse is not nominated by June 2, 2004, it will become forever ineligible.

Late Fees: $
Reinstatement of Eligibility: $
TOTAL Fees Enclosed: $

Please make all checks payable to PERUVIAN FUTURITY.
Certification:
I hereby certify that I have read, understand and agree to abide by the Rules and Regulations of the Peruvian Horse Futurity, and I guarantee that all statements made on this sheet are true. I have enclosed a copy of the registration certificate for each foal nominated.
I have read and agree to comply with the Conditions of Entry on the reverse side of this form.

Signature:__________________________  Taxpayer ID or Social Security #_____________________
More than one form may be used, if necessary.  Any forms received without payment will be returned.