APPLICATION TO REGISTER A RACE MEET

INCOMPLETE APPLICATION WILL NOT BE CONSIDERED! ! ! !

ATTACH ALL NECESSARY INFORMATION.

TO THE MONTANA BOARD OF HORSE RACING:

The undersigned hereby make (s) application to conduct Horse Racing and Pari Mutuel Wagering in accordance with the terms and provisions of the Rules of Racing of the Montana Board of Horse Racing:

NAME: _______________________________________________________________________________________

MAILING ADDRESS:____________________________________________________________________________

LIST DATES APPLIED FOR:______________________________________________________________________

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NO. OF STALLS:_______________________ TRACK SIZE: ___________________________

RACES PER DAY:______________________ DISTANCE: ____________________________

TYPE:_______________________________ PURSES: ________________________________

TYPE OF EMPLOYEE INSURANCE:______________________ AMOUNT: ______________

TYPE OF INSURANCE:______________________ AMOUNT: _________________________

ATTACH COPIES OF MOST RECENT FINANCIAL REPORT:

DESCRIBE YOUR MANAGEMENT PLAN FOR THE UP-COMING RACE SEASON: (Be specific - attached additional sheets, if necessary)

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DESCRIBE YOUR PLANS FOR IMPROVING YOUR FACILITY FOR THE UP-COMING RACE SEASON: (Be specific - attached additional sheets, if necessary)

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LIST ALL NECESSARY EQUIPMENT, AND IT’S CONDITION, WHICH IS AVAILABLE FOR USE AT YOUR RACE MEET: (EXAMPLE - WATER TRUCK, HARROW, STARTING GATE, ETC)

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AS A CONDITION OF THIS APPLICATION - 30 DAYS PRIOR TO YOUR RACE MEET, YOU MUST SUBMIT COPIES OF YOUR HBPA CONTRACT, SIMULCAST CONTRACTS, AND CONTRACT TO LEASE THE FACILITY, TO THE BOARD OF HORSE RACING.

LIST OF YOUR OFFICIALS MUST BE SUBMITTED TO THE BOARD OF HORSE RACING 30 DAYS PRIOR TO YOUR RACE MEET.

YOU MUST HAVE ON FILE WITH THE BOARD OF HORSE RACING AT LEAST 10 DAYS PRIOR TO YOUR RACE MEET, COPIES OF AN ADEQUATE LIABILITY INSURANCE AND JOCKEY INSURANCE.

HAS THIS TRACK BEEN PREVIOUSLY LICENSED? (YES OR NO)

IF SO, WHEN YEAR (S) 20 LICENSE NO

WHEN YEAR (S) 19 LICENSE NO

LIST ALL INDIVIDUALS, FIRMS, ASSOCIATIONS, CORPORATIONS OR PARTNERSHIPS: ATTACH NECESSARY PAPERS, IE. ARTICLES OF INCORPORATION OR PARTNERSHIP PAPERS, ETC.

NAME ADDRESS

____________________________________________________________________________________________

At the time of making this application, are any of the above named individuals, firms, corporations or partnerships under suspension, set down, ruled off or otherwise debarred from racing by any racing organization, association, commission, or recognized turf authority in the United States or elsewhere? (YES/NO)
If yes, please explain. ____________________________________________________________________________

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SIGNATURE OF APPLICANT

TITLE

DATE