PACIFIC COAST HORSE SHOWS ASSOCIATION

                         Horse Show Financial Results

    Competition Name / Dates:

         2003 SAMPLE CLASSIC  11/06/04 ‑ 11/08/04

             Contact/Secretary:  Show Secretary
                         Phone:  (555) 555‑5555

         Medal Class Participants:       Entrants

              Onondarka Medal:               0
              PCHA Adult Horsemanship        0
              PCHA Horsemanship              0
              CPHA Hunt Seat Medal           0
              PHA/WEST Equitation            0
              Foxfield Medal                 0
              CPHA/Mac McHugh Stock Seat     0
              West Coast Equestrians         0
         Total Medal Class Participants:     0   x  $ 2  =  $ 

         PCHA/Jack Baker Reining Classic:    0   x  $10  =  $ 

         Total Number of Horses:
              Hunt/Jump/Equit/Pony ‑         0   x  $ 3  =  $     0.00
                           Western ‑             x  $ 3  =  $ 

         Total Number of PCHA Non‑Members:
              Hunt/Jump/Equit/Pony ‑         0   x  $10  =  $     0.00
                           Western ‑             x  $ 5  =  $ 

              Please Enclose a list
                 of Non‑Members                 AMOUNT DUE  $     0.00

                                     TOTAL AMOUNT ENCLOSED  $ ________

                                       Total Class Entries  :      886
                         Number of PCHA Memberships Enclosed:        6

    Please Enclose a SEPARATE CHECK to West Coast Equestrians for $5.00 per
    each WCE Medal entrant.

    I certify that the above information is accurate to the best of my know‑
    lege. I Hereby authorize the PCHA to verify the information given by
    comparing it to data recieved by other agencies, associations, and/or
    whatever methods may be necessary.

    ____________________________________________________     ______________
         Signature (Manager or Show Officer)                 Date