Nominate

CONTACT

First & Last Name (Yth & Jnr - must be a parent/guardian) *

First

Last

Mobile Number *

Email *

Single, Two-Rider or Team Nomination? *

RIDER/S

Rider 1 *

Rider 2 *

Rider 3 *

Rider 4 *

Rider 5 *

RUNS

Number of Team Runs *

RANDOM RUN - OPEN

Rider 1 would like a Random Run *

Rider 2 would like a Random Run *

Rider 3 would like a Random Run *

Rider 4 would like a Random Run *

Rider 5 would like a Random Run *

PHANTOM (aka Jackpot) RUN - OPEN

Where time, runs and cattle availability permit, we will endeavour to run a Phantom (Jackpot) competition at the end of both days competition. 10 teams are randomly drawn from all names entered. NO Saddle Series Points accumulated, the Phantom is an independent competition. $150 cash to the winning Phantom team. If the Phantom Runs are not held, you will be refunded your $12.

Rider 1 would like a Phantom Run *

Rider 2 would like a Phantom Run *

Rider 3 would like a Phantom Run *

Rider 4 would like a Phantom Run *

Rider 5 would like a Phantom Run *

MEMBERSHIP

Rider 1 - Paying membership with nomination *

Rider 2 - Paying membership with nomination *

Rider 3 - Paying membership with nomination *

Rider 4 - Paying membership with nomination *

Rider 5 - Paying membership with nomination *

Rider 1 Immediate Family Names (up to 2 Open Adults & up to 2 Yth or Jnr) *

Rider 2 Immediate Family Names (up to 2 Open Adults & up to 2 Yth or Jnr *

Rider 3 Immediate Family Names (up to 2 Open Adults & up to 2 Yth or Jnr) *

Rider 4 Immediate Family Names (up to 2 Open Adults & up to 2 Yth or Jnr) *

Rider 5 Immediate Family Names (up to 2 Open Adults & up to 2 Yth or Jnr) *

CAMPING/YARDS/STABLES
Currabubula Recreation Reserve is a LPSC Camping site. There is NO powered sites, however hot showers and toilets are available - donations box at the entry to the camping area. Stables can be booked. Camping is only permitted in designated areas and portable/temporary fencing is permitted for horses in designated areas. A venue map will be distributed.

Will you require camping/stables *

Yes No

Unpowered site - FREE, though must advise if intending to camp
Hot Showers/Toilets - donations box at the entry to the camping area
Stable $13.50/stable/night

If YES, please tell us in detail what camping/stables are required for each family incl, arrival and departure and amount payable *

AMOUNT PAYABLE

Rider 1 - Amt payable (runs) *

Rider 1 - Amt payable (membership) *

Rider 1 - Amt payable (camping/yards/stables) *

Rider 2 - Amt payable (runs) *

Rider 2 - Amt payable (membership) *

Rider 2 - Amt payable (camping/yards/stables) *

Rider 3 - Amt payable (runs) *

Rider 4 - Amt payable (runs) *

Rider 5 - Amt payable (runs) *

Rider 3 - Amt payable (membership) *

Rider 4 - Amt payable (membership) *

Rider 5 - Amt payable (membership) *

Rider 3 - Amt payable (camping/yards/stables) *

Rider 4 - Amt payable (camping/yards/stables *

Rider 5 - Amt payable (camping/yards/stables) *

Please make payment/s NOW before proceeding
Payment via Credit Cardor EFT
fees apply to credit card payments*

EFT DETAILS
Peel Valley Team Penning
BSB 082842
Account 408024583
Please use your surname as the reference
if you are paying via EFT, made up or dummy reference numbers entered below will result in nomination not being accepted

EFT Receipt No. (Rider 1) *

EFT Receipt No. (Rider 2) *

EFT Receipt No. (Rider 3) *

EFT Receipt No. (Rider 4) *

EFT Receipt No. (Rider 5) *

IMPORTANT

If required, we ask you download forms, along with your PVTP membership form and PVTP waiver and email us prior to Wednesday 16th October, 2019

All forms are available on the Membership & Runs - Fees and Forms page

Committee reserve the right to refuse nominations

By clicking submit below you agree to all Terms and Conditions