Address:

City: State: Zip:

e-mail:

I'd like my table near: (we'll try to accomodate your requests)

FEES: amount enclosed

OF Youth Division only (unlimited) (See Rule 5 E)	$20                  AGE OF YOUTH _________	ARE YOU A  4-H MEMBER?  o Yes     o   No
One Open Divsion (unlimited)	$35
Two Open Divisions(unlimited)	$45
Three or more Open Divisions (unlimited)	$55
OR Per Horse Fee: $20 for 1st model; $5 each additional
Proxy $5 per model; $20 unlimited
Sales-Only Table or Extra Table	$20
Entry postmarked April 6 or later	$10 extra

OPTIONAL LUNCH: ORDERS MUST BE PLACED (AND PAID FOR) BY APRIL 5 (postmark date)  

SPONSORSHIPS: (optional) (for each $1 of sponsorship, your name goes in special drawing)
____ classes x $1 each (get free black/white classified or business card ad)
____ championships x $5 each (gets free full page black/white ad)

ADVERTISING IN PROGRAM (BLACK/WHITE):

Classified (50 words or horizontal business card)	$1.00
Half page (copy ready)	$3.00
Full page (copy ready)	$5.00

check or money order (sorry, no PayPal) payable to: Traci Durrell-Khalife TOTAL FEES___________

TO GET EXHIBITOR IDENTIFICATION CODE: (please check one)
o    I've listed an e-mail  address
o I'm enclosing a SASE
   OR
o    I'm participating in the Region 1 "Tag Saver" Program. My entrant code is: __________
        (click here to sign up for the optional "Tag Saver" Program )

MODEL LIST: (KEEP A COPY FOR YOURSELF)
You must provide a typed (or neatly printed) list of models you are showing; it must have your name at the top, be numbered 1,2,3, etc. in ascending order (OK to skip numbers), must include each model's name, breed and finish (OF, CM, or OF Plastic Mini); list may be submitted now, later via e-mail, or on show day; any changes or additions must be provided in writing to the showholder (forms and a drop-box will be provided)

Donations: I plan to donate the following item(s):________________________________
for o Auction (contact Traci)
for o Raffle (items valued over $10; submit your free full page ad --copy ready -- black/white printing)
for o Door Prize (items valued under $10; submit your free classified ad or horizontal business card -- black/white printing)
(donors' names go into special drawing)

The undersigned, on behalf of himself or herself, or if signed by a parent or guardian on behalf of the parent's child or guardian's minor, waives and releases Northwest Expo, its agents and representatives, from any claim or cause of action for any incident, injury, loss or damage to participant or the participant's property suffered as a consequence of or arising out of participation in Northwest Expo Model Horse Show.

Signature of Parent/Guardian or Adult Exhibitor ________________________________________________ Date: ______________________

Tag #

Model's name

Breed

CM/AR

CM/AR Mini

OF Stone

OF Breyer/ Other

OF Plastic Mini

OF China/Resin