2010 KQHA Horse & Rider Master Information

Information on this card will be provided to all show secretaries of KQHA shows in 2010. If you have purchased a 2010 KQHA back number please enter it in the box in the upper right hand corner. This will expedite your entering at the show by eliminating filling out this information each weekend at participating shows.

Horse Information

AQHA Registration No :___________________________________

Horse Name :______________________________________           Sex:_________               Year Foaled:_______                                                                                                 (Stallion, Mare, Gelding)

Owner as listed on papers :_______________________________________________

Owners City :________________________________          State:________________

Responsible Party(person paying bill at show):______________________________________________________

Address :______________________________________________________________

City : ___________________________ State:________ Area Code:_________ Phone No___________________

Exhibitor 1 Information   circle type (Youth, Novice Youth, Amateur, Novice Amateur, Open)

AQHA Number :______________________            Expiration Date:____________     Birth Date:________________

Name as listed on card :___________________________________________________

City :_________________________________                    State:_________________

Exhibitor 2 Information   circle type (Youth, Novice Youth, Amateur, Novice Amateur, Open)

AQHA Number :______________________            Expiration Date:____________     Birth Date:________________

Name as listed on card :___________________________________________________

City :_________________________________                    State:_________________

Exhibitor 3 Information   circle type (Youth, Novice Youth, Amateur, Novice Amateur, Open)

AQHA Number :______________________            Expiration Date:____________     Birth Date:________________

Name as listed on card :___________________________________________________

City :_________________________________                    State:_________________

Exhibitor 4 Information   circle type (Youth, Novice Youth, Amateur, Novice Amateur, Open)

AQHA Number :______________________            Expiration Date:____________     Birth Date:________________

Name as listed on card :___________________________________________________

City :_________________________________                    State:_________________

Please return this form with a photo copy of the horses papers and all AQHA membership cards to:
Peggy Pickford
6707 Aylesbury Rd.
Topeka, KS 66610