Name:______________________________________________________

Address:____________________________________________________

City:________________________________________________________

Phone Number:_______________________________________________

Age as of January 1st:_________________________________________

If Awarded this position of Representative (Sweetheart, Junior Sweetheart, Horseman, or Junior Horseman), I will assume all responsibilities bestowed upon that position. I agree to return the crown or hat band to the club at the end of my term.

Signature of Applicant:_________________________________________

Signature of Parent or Guardian:_________________________________

Date:__________________________