2015 Santa Maria Elks Minetti Mini Rodeo Contestant Qualifier Entry Form Sunday - April 26th, 2015 May 28th – 31st, 2015 We will be selecting this year’s contestants for the Minetti Mini Rodeo at our Mini Rodeo Qualifying Event. This year’s Qualifying Event will be held on Sunday - April 26th, 2015 at the Elks Unocal Event Center. To enter an event, please fill out the form below and return to the committee by the deadline date of Friday – April 17th, 2015. Mark the box for the selected events you wish to enter. Return the completed form to the address below with appropriate entry fees. Money payouts will be awarded in each event. Send Completed Form and Entry Fees to: Elks Recreation Inc., 1309 N. Bradley Road, Santa Maria, CA 93454. Contestant Name: Parent Name: Mailing Address: Street City Phone: State Zip Cell Phone: Email: Birthdate: _______________ (Must show proof of age) Please select the events that you wish to participate in ($25.00 per Event, $25.00 per partner for Team Roping): (For all events must be age as of 04/26/15) □ Jr. Team Roping (Ages 9 – 17) Go three times □ Barrel Race (6 & under) Must be “unassisted” □ Barrel Race (Ages 7 – 9) □ Barrel Race (Ages 10 – 13) □ Barrel Race (Ages 14 – 17) Partner #1: Partner #2: Partner #3: □ Breakaway Roping (12 & under) □ Breakaway Roping (13 – 17) Total Entry Fees Due: $ FOR OFFICE USE ONLY Total # of Events: x $25.00 = $ __ Proof of Age Confirmed By: Release of Liability (Elks Recreation, Inc.) □ Total Received: $ __ Birthdate: ____________ Medical Authorization □ □ CASH □ CHECK #_______ 1309 N. BRADLEY ROAD, SANTA MARIA, CA 93454 • OFFICE: (805) 925-4125 FAX: (805) 925-4578 WEBSITE: WWW.ELKSREC.COM EMAIL: [email protected]