Rider's Name:_____________________________________Birth Date:________________________
Horse1 Name:_____________________________________Breed:___________________________
Horse2 Name:_____________________________________Breed:___________________________
Address:__________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Home Phone #:______________________________Work #:________________________________
Cell #:______________________________________Emergency #:___________________________
Email Address 1:____________________________________________________________________
Email Address 2:____________________________________________________________________
There is a $55.00 Membership Fee for each horse entered in the Finals by the rider. In addition,
in order to qualify for GSBR Finals each horse must be ridden in half of the GSBR Sanctioned
Shows, up to a maximum of 10 Shows. Pee Wee membership is $25.00 for each horse and must be ridden in a total of 4 shows to win a gift at the 2008 finals. Checks can be made payable to CASH or G. Tobias and can be handed in at any show or mailed to the following address:
GERARD TOBIAS
171 Provinceline Rd.
Wrightstown NJ 08562
Member Signature___________________________________________________________________
Legal Signature (persons under the age of 18 must be signed by a parent or guardian)
Date:________________ Amount Paid:________________ Received by:___________________
