14 Hasler Rd, Osborne Park, WA 6017 | Ph: (08) 9445 5277 | email: racing@rwwa.com.au westspeed.com.au | ABN: 21 347 055 603

RACING AND WAGERING WESTERN AUSTRALIA WESTSPEED STANDARD OWNER NOMINATION FORM

2020 Nomination Details for 2018 Foals

Horses by a Westspeed Platinum Stallion will be considered as Westspeed Platinum during their race career, earning further bonuses during their two-year-old (2YO) and 3YO seasons. Owners have the option of paying a “4YO Extension for Platinum Horses Only” fee to become

eligible for bonuses for 4YO winners below 1750m. Please click here for the Westspeed Platinum Owner Nomination Form.

NOMINATOR DETAILS

This form does not need to reflect the full details of the yearling’s ownership. This information will be recorded when the ‘Application to Register a Horse’ form is lodged with the Registrar of Racehorses.

Name ______________________________________________________________________________________________

Address ______________________________________________________________________________________________

______________________________________________________________ Postcode ______________________

Telephone _________________________________________ Email ______________________________________________

NOMINATIONS CLOSE AT 4PM ON THURSDAY, 16 JULY 2020

NOMINATED YEARLING

DECLARATION

I declare that the details above are true and accurate, and the nomination(s) meet the criteria set out in the Westspeed Conditions.

Signature _______________________________________ Date __________ /__________ /_________

OFFICE USE ONLY

PI No: Receipt No: Date: Amount Paid: $

Option A: Westspeed Owner Nomination Only $2,200 (inc. $200 GST)

Sire Dam Sex Nomination Type Fee Paid E.g. Option A E.g. $2,200

Total Paid $

14 Hasler Rd, Osborne Park, WA 6017 | Ph: (08) 9445 5277 | email: racing@rwwa.com.au westspeed.com.au | ABN: 21 347 055 603

PAYMENT METHOD

If payment is made electronically, forms may be submitted by email to racing@rwwa.com.au.

☐ Credit Card Complete below, or phone (08) 9445 5277

☐

BPAY Biller code and reference provided by email on receipt of Nomination Form

☐ Cheque Attach to Nomination Form

Cardholder Name

_________________________________________________________________

Credit Card (Please tick) ☐ VISA ☐ MasterCard

Card Number ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ ☐☐☐☐ CVV (3 digit number on reverse of card) ☐☐☐

Expiry Date

_________ / __________

Amount

$_________________________

Signature

__________________________

Date

__________ /__________ /_________