Nebraska Rodeo Queen Clinic

Please fill out the following Application Form, Print it out and Mail to the address listed under Mailing Information
      Please see the 2012 Queen Clinic Brochure & Schedule
for Registration Guidelines & Details
Applicant Information
First Name
 Last Name
 Applicant Title (if applicable)
Address Line 1
 Address Line 2
  
City
 State
 Zip Code
Phone Number
 Age
 Applicant E-Mail
Coach/Parent Information
First Name
 Last Name
 Coach/Parent/Director  Title (if applicable)
Address Line 1
 Address Line 2
  Check this Box if Coach/Parent/Director's Address/Phone Number is the same as Applicant's Address/Phone Number
City
 State
 Zip Code
Phone Number
 Coach/Parent E-Mail
Registration  Information
Group 1 Girls (19 -26)  $  x $150.00
Group 2 Girls (14 to 18) $   x $150.00
Group 3 Girls (11 to 13)  $  x $60.00
Horsemanship for Group 1 & 2 Participants ONLY. Clinic workbooks included
Must bring your own horse, no horses will be provided  --NO STALLIONS ALLOWED -- 
I will bring my horse Yes __  No ___    Number of days for stalls  ______x $10=$
Coaches/ Parent/Pageant Directors  $   x $60.00
Clinic Notebooks 
(Included in fee for Groups 1-2-3)		 $   x $30.00
Judges Seminar $   x $25.00
Association Adult MRNA members $   x $20.00
Association Members(meals only) $   x $ 5.00
# of people for the Mercantile                                            ________ x $10 =$  
Pageant Directors & Mothers Can Attend Their Meeting At No Charge 
Total Amount Enclosed -     $
Comments

Mailing Information
 Please include check or money order payable to Miss Rodeo Nebraska Association, Inc.

Please mail to:   MRNA Rodeo Queen Clinic
Lolly Klug, PO Box 160, Maxwell NE 69151
clinic@missrodeonebraska.org 


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