HORSEMEN HELPING HORSEMEN

I AM A MEMBER OF THE KENTUCKY HORSEMEN'S BENEVOLENT AND PROTECTIVE ASSOCIATION. I UNDERSTAND THAT I AM ENTITLED TO ALL BENEFITS ESTABLISHED BY THE HBPA FOR ITS MEMBERS.

I hereby appoint the Kentucky Horsemen's Benevolent and Protective Association, Inc. to act as my sole and exclusive agent and representative for the purpose of negotiating and executing, or refusing to execute, with Thoroughbred race tracks in Kentucky, any and all contracts and agreements relating to Thoroughbred racing in the state. By this appointment I hereby revoke any and all previous authorities given by me for similar purposes.

NAME (please print) ________________________________________________ STABLE OR CORPORATION NAME (if applicable)________________________________________________ ADDRESS ____________________________________________________________ CITY _____________________STATE___________________ZIP_______________ (check one) OWNER_________TRAINER_________OWNER/TRAINER_____________ EMAIL ______________________________________________________________ SIGNATURE___________________________________DATE____________________

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Kentucky Horsemen's Benevolent & Protective Association
3733 South Fourth St, Louisville, KY 40214
502-363-1077 * toll free 800-928-4272 * fax 502-367-6800 * email kyhbpa@insightbb.com