PLEASE PRINT FORM OUT & MAIL WITH PAYMENT TO: UBRA; 960 Bunyan Ave, Balsam Lake, WI 54810
Contact Jessica to pay via credit card (715) 857-6343 or Jessica@ubra.org

One Form Per Rider - Open to EVERYONE - Must have UBRA Membership to be eligible for Added $ & Awards
Please make note if you wish to carry over times from Futurity or Derby.

Name:

Phone :

Social Security #

UBRA #

Address:

City

State, Zip:

Email :

Write your horses name / names in the spaces below.

FRIDAY
SATURDAY
SUNDAY
Friday CFTS Open 4D
$20 Entry Fee
$250 Added
Division Awards

Saturday CFTS Open 4D
$30 Entry Fee
$500 Added
& Division Awards

Sunday CFTS Open 4D
$30 Entry Fee
$500 Added &
Division Awards

1.

1.

1.

2.

2.

2.

3.

3.

3.

Friday Youth 4D
$10 Entry Fee

Division Awards

Saturday Youth 4D
$10 Entry Fee

Division Awards

Sunday Youth 4D
$10 Entry Fee

Division Awards

1.

1.

1.

2.

2.

2.

3.

3.

3.

Friday 2nd Open 4D
$20 Entry Fee

$250 Added
Saturday 2nd Open 4D
$20 Entry Fee

$250 Added
Sunday 2nd Open 4D
$20 Entry Fee
$250 Added

1.

1.

1.

2.

2.

2.

3.

3.

3.

Total Entry Fees: $ __________  
Office Fee:
$15
Processing Fee Per person ($10 per day for on site entries)
NO OFFICE FEE FOR JJCLASSIC ENTRIES
Shavings: $ _________ Shavings ($6 per bag)
Electrical: $ __________ Electrical hook-up ($30 wknd, $25 per night),
Stall Fee: $ __________ $40 for the first stall, $30 for each additional stall (Sat & Sun only $30, adtl stalls $25)
Tie Outs: $ __________ Tie/Jump Outs $10 per day per person for everyone not getting stalls
Tie Outs are NOT ALLOWED FOR OVERNIGHT USE - YOU MUST HAVE A STALL
Banquet Ticket
$10
$10 per person. Includes meal and entry in prize drawings
Total Fees: $ __________ Add 5% for entries paid via credit card
Make Checks Payable to: UBRA ~ Send entries & checks to: UBRA; 960 Bunyan Ave, Balsam Lake, WI 54810

I understand the United Barrel Racing LLC and Rhino Arena are not responsible for any loss or damage that may occur to me, my horse, and any of my family members or property. It is my responsible to carry insurance on all this things and I agree to hold harmless United Barrel Racing LLC and Rhino Arena for any loss that I may incur at this event.

_______________________________________________ Date ____________
Signature (18 or under parent or legal guardian must sign

We're glad you're coming - drive carefully!  Questions contact Jessica (715) 857-6343 or info@ubra.org