Futurity Renomination Form
for horses already participating in the Futurity

Use this form to renominate horses already in the Futurity. Please type or print. Fill out and mail this form and all fees to: Peruvian Futurity, 3095 Burleson-Retta Rd., Burleson, TX 76028   Tel.# 817-447-2703
Submit this form on or before May 1, 2004 (or late fees apply, see below)

Your Name: Ranch Name:

Address: Email:

City, State, Zip: Telephone:

I wish to Renominate the following horses that have been previously nominated:
Check S M or G to indicate sex of horse.

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

Birthdate: Sire:    Dam:

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

Birthdate: Sire:    Dam:

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

Birthdate: Sire:    Dam:

TOTAL Renomination Fees ($150 each): $

(if your nomination is postmarked between May 1 and August 1, 2002, you must include a $50 LATE fee per horse in addition to the fees shown above.

Late Fees: $
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.

Signature:__________________________  Taxpayer ID or Social Security #__________________________

This form must be accompanied by the signed and dated Conditions of Entry form.
More than one form may be used, if necessary.  Any forms received without payment will be returned.