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ESQHA PROMOTION AWARD 200_

Horse's Name	______________________	Owner's Name		_____________________________	Rider's Name	____________________________
Registration No	______________________	Address		_____________________________	Address	____________________________
Yr. Foaled	____________			_____________________________		____________________________
Sex	____________	Phone		_______________	Phone	________________
		Age of Rider		(as of Jan. 1)______________
Name of Show	______________________	Date of Show		_________________________

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Name of Class	Placing or % Score	# of Horses in Class	ESQHA use only
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I hereby verify that the above information is correct.

________________________________________	______________________________________	_______________________________________	__________
Signature of show secretary	Name of show secretary	Address	Phone

This form may be photocopied