Open Entry Form

Dixie Classic - Open Entry Form
Rider

First NameLast Name
Rider Date of Birth

MonthDayYear
Date
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Open 5D has 1/2 second splits. Age Incentives are 3D with 1 second splits.

Age Incentives are 0-18, 19-49, 50-? based on rider's age on 3/13/2021.

Future Fortunes Regional Championship is for Saturday Open with no additional fee. MUST SUBMIT ENTRY FORM AND REGISTRATION PAPERS BEFORE 3/13/2021.
Horse 1 Registered Name
Future Fortunes

Yes-must submit required entry form with registration papersNo
Horse 1 Entries

Friday Jackpot - $25Saturday Open - $65Saturday Age Incentive carry-over - $30SWBRA Sat Co-Sanction - $5Sunday Open - $65Sunday Age Incentive carry-over - $30SWBRA Sun Co-Sanction - $5
Horse 1 Total
Horse 2 Registered Name
Future Fortunes

Yes-must submit required entry form with registration papersNo
Horse 2 Entries

Friday Jackpot - $25Saturday Open - $65Saturday Age Incentive carry-over - $30SWBRA Sat Co-Sanction - $5Sunday Open - $65Sunday Age Incentive carry-over - $30SWBRA Sun Co-Sanction - $5
Horse 2 Total
Horse 3 Registered Name
Future Fortunes

Yes-must submit required entry form with registration papersNo
Horse 3 Entries

Friday Jackpot - $25Saturday Open - $65Saturday Age Incentive carry-over - $30SWBRA Sat Co-Sanction - $5Sunday Open - $65Sunday Age Incentive carry-over - $30SWBRA Sun Co-Sanction - $5
Horse 3 Total
Horse 4 Registered Name
Future Fortunes

Yes-must submit required entry form with registration papersNo
Horse 4 Entries

Friday Jackpot - $25Saturday Open - $65Saturday Age Incentive carry-over - $30SWBRA Sat Co-Sanction - $5Sunday Open - $65Sunday Age Incentive carry-over - $30SWBRA Sun Co-Sanction - $5
Horse 4 Total
Prepaid Time Onlys

Each one - $5
Quantity
Time Only Total
See time only schedule on website for availability and ENTER REQUEST HERE.
Time slots each half hour
Additional Items*

Processing Fee - $10
Additional Items*

Late fee after March 3 - $10
Signature of Participant or Legal Guardian

Clear
Total owed
Payments can be submitted by Venmo @dixieclassic or mail a check to

Dixie Classic at 394 S Main Street, Washington, UT 84780.

Entry is complete when your payment is received.
Should be Empty:

Dixie Classic - Open Entry Form