FORTUNE TEAM CHASE ENTRY FORM
Sunday 24th October, 2004
ENTRIES CLOSE TUESDAY 19th OCTOBER 2004

Class 1 - THE FUN EVENT - Entry Fee £40.00 per team (LATE ENTRY - £50.00) + medical cover
Class 2 - OPEN QUALIFIER - Entry Fee £80.00 per team (LATE ENTRIES - £90.00) + medical cover
CLASS
NO:
NAME OF RIDER
NAME OF HORSE
NAME OF TEAM
ELIGIBLE FOR
WHICH SPECIAL
PRIZE
(Class 1 only)
COUNTRYSIDE
ALLIANCE NO:
FEE £
             
             
             
             
             
             
             
              
I have read the rules. I and all members of my team agree to all conditions in the schedule

Signature of person responsible _________________________________________ Tel No._________________________

Address ___________________________________________________________________________________________

__________________________________________________________________________________________________

 Total entry fee(s)

  
+ medical cover @
£4 per team		  
Total enclosed

  


NO ENTRIES WILL BE ACCEPTED WITHOUT CORRECT FEE


CHEQUES SHOULD BE MADE PAYABLE TO THE FORTUNE TEAM CHASE AND SENT TOGETHER WITH THE ENTRY FORM AND AN SAE TO:
The Secretary: Mrs D. Longland 5, Magpie Driv, Totton, SOUTHHAMPTON, SO40 87E. Telephone: 02380 663310