I would like to compete for the following Tri-Cities Representative:

___ Sweetheart; girls 11 - 17 years of age
___ Horseman; boys 11 - 17 years of age
___ Jr. Sweetheart; girls under 11 years of age*
___ Jr. Horseman; boys under 11 years of age*
    Age is as of January 1st of the current year.
    *must be able to control their horse without assistance.

Name:______________________________________________________

Address:____________________________________________________

City:________________________________________________________

Phone Number:(______)___________________ E-Mail:_____________________

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.

Signature of Applicant:_________________________________________

Signature of Parent or Guardian:_________________________________

Date:__________________________

Application must be received by April meeting.

Mail to: Lauri Abed, 111 Sequoia Way, Martinez CA 94553