MQHA  OUTSIDE  ACTIVITIES  PROGRAM

Member’s Name_______________________________________________________________

Horse’s Name__________________________________________Reg. No.________________

Name of Event_________________________________________Event Date______________

Signature of Event Official_______________________________________________________
                      Please sign to the correctness of the provided information

Mail to: MQHA, Mary Baker-Youderian, P. O. Box 131, Stanford, MT 59479 along with $2.00 per show 
within 15 days of the event.  Please use one form per show.

Class Name

No. of Entries

Placing

Office Use