Memphis Entry Form June 2022 Entry Form - Lucky Dog Memphis, June 3-5 For individuals entering online for a Lucky Dog event. "*" indicates required fields Open Pre-entries may request to be drawn into any group of 50 - Requests MUST accompany original form. Entries accepted onsite until the FIRST horse runs each day. See website for rules and complete event details. All Future Fortunes Horses must submit an official FF entry form and a copy of registration papers to be eligible for the $50,000 FF Bonus Money on Saturday. No copies of horse papers for FF will made at the show office, bring your own copies! Entry IDRider InformationName* First Last Please Check Appropriate Side-Pot Group:*Based on your age as of Mar 4, 2022. Youth (18 and under) Adult (19 - 44) Senior (45+) I am not entering any age-based side pots. CREDIT CARD BILLING Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Rider Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please check if recent change of address Contact InfoEmail* Phone*Membership ID NumbersWPRA # BBR # OPEN and SIDEPOT ENTRIESFriday Open will start at 12:00 PM. Saturday Open will start after the 9:30 AM Peewee Race. Sunday Open will start after the 9:00 AM Pony Race. 2022 Membership required to enter Running with the Pack side pots. HiddenProduct Fields are Defined in this Section. This is not visible online.Friday Horse 1 Price: Friday Horse 2 Price: Friday Horse 3 Price: Friday Horse 4 Price: Friday Horse 5 Price: Saturday Horse 1 Price: Saturday Horse 2 Price: Saturday Horse 3 Price: Saturday Horse 4 Price: Saturday Horse 5 Price: Sunday Horse 1 Price: Sunday Horse 2 Price: Sunday Horse 3 Price: Sunday Horse 4 Price: Sunday Horse 5 Price: # of PRE-BED SHAVINGS Price: Running with the Pack Price: Entry DetailsHow many horses do you want to enter on this form?*12345NoneHorse 1 Entry DetailsHorse #1 Registered Name Friday Group of 50 Request Horse 1No Preference1 to 5051 to 100101 to 150151 to 200201 to 250251 to 300301 to 350351 to 400401+All Friday Entries Horse 1 $100 Fri Open $1000 Added $20 Fri Rider Age Side Pot $50 Sat Futurity Side Pot $50 Sat Derby Side Pot Saturday Group of 50 Request Horse 1No PreferencePeeWee Carry Over1 to 5051 to 100101 to 150151 to 200201 to 250251 to 300301 to 350351 to 400401 to 450451 to 500500+All Saturday Entries Horse 1 $25 Sat Peewee Race $60 Sat Open $2,500 Added $20 Sat Rider Age Side Pot $25 Sat Running With Pack $1,000 Add $50 Sat Futurity Side Pot $50 Sat Derby Side Pot Sunday Group of 50 Request Horse 1No PreferencePony Carry Over1 to 5051 to 100101 to 150151 to 200201 to 250251 to 300301 to 350351 to 400401 to 450451 to 500500+All Sunday Entries Horse 1 $25 Sun Pony Race $60 Sun Open $2,500 Added $20 Sun Rider Age Side Pot $25 Sun Running With Pack $1,000 Add $50 Sun Futurity Side Pot $50 Sun Derby Side Pot Horse 2 Entry DetailsHorse #2 Registered Name Friday Group of 50 Request Horse 2No Preference1 to 5051 to 100101 to 150151 to 200201 to 250251 to 300301 to 350351 to 400401+All Friday Entries Horse 2 $100 Fri Open $1000 Added $20 Fri Rider Age Side Pot $50 Sat Futurity Side Pot $50 Sat Derby Side Pot Saturday Group of 50 Request Horse 2No PreferencePeewee Carry Over1 to 5051 to 100101 to 150151 to 200201 to 250251 to 300301 to 350351 to 400401 to 450451 to 500500+All Saturday Entries Horse 2 $25 Sat Peewee Race $60 Sat Open $2,500 Added $20 Sat Rider Age Side Pot $25 Sat Running With Pack $1,000 Add $50 Sat Futurity Side Pot $50 Sat Derby Side Pot Sunday Group of 50 Request Horse 2No PreferencePony Carry Over1 to 5051 to 100101 to 150151 to 200201 to 250251 to 300301 to 350351 to 400401 to 450451 to 500500+All Sunday Entries Horse 2 $25 Sun Pony Race $60 Sun Open $2,500 Added $20 Sun Rider Age Side Pot $25 Sun Running With Pack $1,000 Add $50 Sun Futurity Side Pot $50 Sun Derby Side Pot Horse 3 Entry DetailsHorse #3 Registered Name Friday Group of 50 Request Horse 3No Preference1 to 5051 to 100101 to 150151 to 200201 to 250251 to 300301 to 350351 to 400401+All Friday Entries Horse 3 $100 Fri Open $1000 Added $20 Fri Rider Age Side Pot $50 Sat Futurity Side Pot $50 Sat Derby Side Pot Saturday Group of 50 Request Horse 3No PreferencePeewee Carry Over1 to 5051 to 100101 to 150151 to 200201 to 250251 to 300301 to 350351 to 400401 to 450451 to 500500+All Saturday Entries Horse 3 $25 Sat Peewee Race $60 Sat Open $2500 Added $20 Sat Rider Age Side Pot $25 Sat Running With Pack $1000 Add $50 Sat Futurity Side Pot $50 Sat Derby Side Pot Sunday Group of 50 Request Horse 3No PreferencePony Carry Over1 to 5051 to 100101 to 150151 to 200201 to 250251 to 300301 to 350351 to 400401 to 450451 to 500500+All Sunday Entries Horse 3 $25 Sun Pony Race $60 Sun Open $2500 Added $20 Sun Rider Age Side Pot $25 Sun Running With Pack $1000 Add $50 Sun Futurity Side Pot $50 Sun Derby Side Pot Horse 4 Entry DetailsHorse #4 Registered Name Friday Group of 50 Request Horse 4No Preference1 to 5051 to 100101 to 150151 to 200201 to 250251 to 300301 to 350351 to 400401+All Friday Entries Horse 4 $100 Fri Open $1000 Added $20 Fri Rider Age Side Pot $50 Sat Futurity Side Pot $50 Sat Derby Side Pot Saturday Group of 50 Request Horse 4No PreferencePeewee Carry Over1 to 5051 to 100101 to 150151 to 200201 to 250251 to 300301 to 350351 to 400401 to 450451 to 500500+All Saturday Entries Horse 4 $25 Sat Peewee Race $60 Sat Open $2500 Added $20 Sat Rider Age Side Pot $25 Sat Running With Pack $1000 Add $50 Sat Futurity Side Pot $50 Sat Derby Side Pot Sunday Group of 50 Request Horse 4No PreferencePony Carry Over1 to 5051 to 100101 to 150151 to 200201 to 250251 to 300301 to 350351 to 400401 to 450451 to 500500+All Sunday Entries Horse 4 $25 Sun Pony Race $60 Sun Open $2500 Added $20 Sun Rider Age Side Pot $25 Sun Running With Pack $1000 Add $50 Sun Futurity Side Pot $50 Sun Derby Side Pot Horse 5 Entry DetailsHorse #5 Registered Name Friday Group of 50 Request Horse 5No Preference1 to 5051 to 100101 to 150151 to 200201 to 250251 to 300301 to 350351 to 400401+All Friday Entries Horse 5 $100 Fri Open $1000 Added $20 Fri Rider Age Side Pot $50 Sat Futurity Side Pot $50 Sat Derby Side Pot Saturday Group of 50 Request Horse 5No PreferencePeewee Carry Over1 to 5051 to 100101 to 150151 to 200201 to 250251 to 300301 to 350351 to 400401 to 450451 to 500500+All Saturday Entries Horse 5 $25 Sat Peewee Race $60 Sat Open $2500 Added $20 Sat Rider Age Side Pot $25 Sat Running With Pack $1000 Add $50 Sat Futurity Side Pot $50 Sat Derby Side Pot Sunday Group of 50 Request Horse 5No PreferencePony Carry Over1 to 5051 to 100101 to 150151 to 200201 to 250251 to 300301 to 350351 to 400401 to 450451 to 500500+All Sunday Entries Horse 5 $25 Sun Pony Race $60 Sun Open $2500 Added $20 Sun Rider Age Side Pot $25 Sun Running With Pack $1000 Add $50 Sun Futurity Side Pot $50 Sun Derby Side Pot Other Sanctioned Rodeo Info Since you entered a Rodeo side pot, please provide the name of the rodeo association and your member number if appropriate.RV Hookups and Stalls*Pre-paid stalls will be unlocked with your name on them upon arrival. *Be sure to pay for ALL nights needed! Any special stall or hookup requests? Requests are granted in the order they are received.VIP RV Price: Stalls Thursday Price: Stalls Friday and Saturday Price: Stalls Saturday Price: Stalls Sunday Price: Weekend RV Hookup Price: Sunday RV Hookup Price: #stalls Thursday night ($30)?Please enter a number from 0 to 20.#stalls Friday & Saturday night ($60)?Please enter a number from 0 to 20.#stalls Sunday night ($30)?Please enter a number from 0 to 20.#stalls Saturday night ($30)?Please enter a number from 0 to 20.VIP RV Hookups 107 114* 30 amp, No Sewer 115* 30 amp, No Sewer .116* 30 amp, No Sewer # Weekend RV Hookups ($80) (Thurs - Sat)Please enter a number from 0 to 3.Standard, NOT VIP Hookups # Sunday RV Hookups ($30)Please enter a number from 0 to 3.How many bags of shavings? $8.50 eaPlease enter a number from 0 to 50.Pre-bedding $8.50 per bag.Add a Running with the Pack membership ($50) (2022 membership expires 12/31/22)No thanks.Yes, please!Online Entry Fee Price: Subtotal $0.00 Credit card fees (5%) $0.00 Coupon Total PLEASE NOTE: CREDIT CARD FEES ARE NOT REFUNDABLE. Under Tennessee law, an equine activity sponsor is not liable for an injury to, or the death of, a participant in equine activities resulting from the inherent risk of equine activities. I understand that every effort will be made to ensure the safety of each contestant and his/her horse(s). I hereby release Lucky Dog Productions, the Agricenter Showplace Arena and all sponsors involved. I also acknowledge that I have read, understand, and agree to abide by the rules of Lucky Dog Productions and any ground rules enforced for specific events. (See website for rules and complete event details.)Liability Release* I have read and agreed to the release of liability. Secure Credit Card Card Holder* Card Number* Card Expiration* Card CVV* Please check your email for entry confirmation! If you do not receive an email receipt, we may not have your entry! Please also review your confirmation for any errors or omissions.NameThis field is for validation purposes and should be left unchanged.
