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Summer Spectacular Logo

2021 NCHA Derby / Classic Challenge

Entry Form

Mailing Address: 260 Bailey Ave Fort Worth, TX 76107

Phone: 817-244-6188 | Fax: 817-244-2015 | Email: cclaxton@nchacutting.com




(Combination entries ride to the herd one time, score counts for each level entered. NCHA fee applied only once to combination entries) *PAC Fee included: Under Texas Election Code, Chapter 253, the Political Action Committee (PAC) fee is a voluntary contribution. Funding the PAC is important to be able to maintain state funding at the NCHA Triple Crown events. Your contribution will provide critical assistance to the NCHA with this effort. To opt out of the PAC fee, submit your payment without the amount indicated as the PAC fee for your class.

Late Entries in all Events require a penalty. Entries not accepted without payment.

*** PAYMENT 1 DUE MAY 7, 2021 *** PAYMENT 2 DUE JUNE 4, 2021 ***

Class Entry Fee Senior Gelding Chrome Cash Novice Total
Open / Intermediate+
LTE: $750,000 or more
1. $1,450 2. $1,550*
Total with Two Payments: $3,000
$535 $535 $535 $535
(4 year old only)
$0
Intermediate Open Sub-classes
LTE: $200,001 - $749,999
+Eligible Riders will be automatically entered into the intermediate for no additional fee.
But sub-classes must be entered separately.
$535 $535 $535 $0
Limited Open
LTE Cap: $200,000
1. $600 2. $700*
Total with Two Payments: $1,300
$535 $535 $535 $0
Non Pro
LTE: $500,000 or more
1. $1,250 2. $1,425*
Total with Two Payments: $2,675
$535 $535 $535 $535
(4 year old only)
$0
Intermediate Non Pro
LTE: $100,001 - $499,999
1. $800 2. $975*
Total with Two Payments: $1,775
$535 $535 $535 $0
Limited Non Pro
LTE Cap: $100,000
1. $535 2. 710*
Total with Two Payments: $1,245
$535 $535 $535 $0
Non Pro-Intermediate
Combination Entry
1. $1,800 2. $2,080*
Total with Two Payments: $3,880
$0
Intermediate-Limited
Combination Entry
1. $1,200 2. $1,350*
Total with Two Payments: $2,550
$0
Non Pro-Limited
Combination Entry
1. $1,600 2. $1,850*
Total with Two Payments: $3,450
$0
Non Pro-Int-Limited
Combination Entry
1. $2,200 2. $2,455*
Total with Two Payments: $4,655
$0
Amateur
LTE: $100,000 or more
1. $650 2. $850*
Total with Two Payments: $1,500
$535 $535 $535 $535
(4 year old only)
$0
Intermediate Amateur
LTE: $25,001 - $99,999
1. $545 2. $745*
Total with Two Payments: $1,290
$535 $535 $535 $0
Limited Amateur
LTE Cap: $25,000
1. $345 2. $550*
Total with Two Payments: $895
$535 $535 $535 $0
Amateur-Intermediate
Combination Entry
1. $1,000 2. $1,295*
Total with Two Payments: $2,295
$0
Intermediate-Limited
Combination Entry
1. $745 2. $945*
Total with Two Payments: $1,690
$0
Amateur-Limited
Combination Entry
1. $845 2. $1,055*
Total with Two Payments: $1,900
$0
Amateur-Int-Limited
Combination Entry
1. $1,200 2. $1,495*
Total with Two Payments: $2,695
$0
Grand Total: $

(Combination entries ride to the herd one time, score counts for each level entered. NCHA fee applied only once to combination entries) *PAC Fee included: Under Texas Election Code, Chapter 253, the Political Action Committee (PAC) fee is a voluntary contribution. Funding the PAC is important to be able to maintain state funding at the NCHA Triple Crown events. Your contribution will provide critical assistance to the NCHA with this effort. To opt out of the PAC fee, submit your payment without the amount indicated as the PAC fee for your class.

Late Entries in all Events requires a penalty. Entries not accepted without payment.

* Includes a $50 NCHA fee, $25 Drug Fee and voluntary PAC Fee.
# Includes a voluntary PAC Fee.
(PAC Fee = $100 for All Open and Combos, $75 for All Non-Pro and Combos, $20 for All Amateur and Combos)

Funding the PAC is important to be able to maintain state funding at the NCHA Triple Crown.

Select this option to opt out of PAC Fee.  Additional PAC Fee Contribution

Photocopy of registration certificate or colored application for unregistered horses must accompany this application. Due in office by June 4, 2021.
RELEASE FROM LIABILITY AND WAIVER OF RESPONSIBILITY: As a condition to participate in this event, the NCHA, the directors, officers, employees, members, agents and representatives are hereby released from all claims, demands, or causes of action of any kind or nature whatsoever; whether now existing or to hereafter accrue, on account of any damage, cost or expense (I) As a result of any bodily injury, loss or damage to any animals, equipment or other personal property, from any cause whatsoever including, but not limited to, the sole or concurrent negligence of NCHA, its directors, officers, employees, agents or representatives; or (ii) as a result of the interpretation or enforcement of the NCHA constitution, bylaws, rules or regulations and the risk of any such damage, cost or expense which may occur by reason of forgoing is hereby assumed and accepted. This waiver is binding on the undersigned as well as all riders, grooms and other helpers associated with the participation of the horse (s) described herein in this event and the undersigned indemnifies the NCHA from all claims, demands, or causes of action based on any of the foregoing. Both owner and rider of any horse entered in an NCHA produced event, by said entry, consents to the implementation of any action allowed by Standing Rule 35.a, Zero Tolerance by either show management or judge.

Electronic Agreement: If "YES" is not selected then this application will not be accepted.

Accepted Payments:
visa amx mastercard

$ 0
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260 Bailey Ave.
Fort Worth, TX 76107
(817) 244-6188

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