Foaling Date *

MM

DD

YYYY

*

Mare

Gelding

Stallion

Nominator(s) Name *

First Name

Last Name

Owner(s) Name *

First Name

Last Name

Phone *

(###)

###

####

Payment Information as follows: *

Weanling: $285.00 (Before January 15th following the Weaning year)

Yearling: $570.00 (After January 15th of the Yearling year)

2 Years: $775.00 (After January 15th of the two-year-old year)

3 Years: $1,500.00 (After January 15th of the three-year-old year)

4 Years: $400.00

5 Years: $200.00

6 Years: $100.00

7 Years: $50.00

Must have a valid ORHA Membership at time of enrollment And for the years showing. Non Members Must purchase and pay for a membership at time of nomination. Current members Must include a copy of your ORHA or proof of payment with this nonimation form. *

Please Indicate your form of payment

E-Transfer

Cheque

Cash