American International Charolais Association

HOMEPAGE

A Royal Roundup
2011 AIJCA Junior National
June 26 - July 1, 2011
Kansas City, MO

2011 JUNIOR NATIONAL ONLINE REGISTRATION FORM

If registering a % Heifer or Steer from the Other Breeds AND Not attending the Charolais conference,
please notify the AICA Office for Manual Registration Requirements.
Call 816.464.5977, Ext. 201. You will be required to be an AIJCA member and required to purchase an AIJCA Show T-shirt to participate.

Junior National Participant Information
One registration form per junior or adult participant.

FIRST NAME:

LAST NAME:

SEX:

Male

Female

AIJCA BREEDER NUMBER:

AGE AS OF MAY 20, 2011:

PHONE:

() - EXT.

COMPLETE MAILING ADDRESS:

CITY:

STATE:

ZIP:

PLUS 4:

E-MAIL:

JUNIOR OR ADULT:

Junior

Adult

Show Entries
Refer to the show rules and regulations before completing this portion. Entry not valid unless registration paper is in the EXHIBITOR’S NAME by the entry deadline.

HEIFERS (Owned and Bred & Owned) • Calved after September 1, 2009
Entry not valid unless REGISTRATION paper is in the EXHIBITOR’S NAME by the entry deadline.
If your heifer entry will be shown in the Bred & Owned Heifer Show ($10 entry fee required), you must place a check mark in the box, following the heifer’s AICA Reg. No. Bred & Owned heifers are not automatically entered in the Bred & Owned Heifer Show, but must be entered in the “Owned Show” to be eligible for the Bred & Owned Show.

ANIMAL NAME	BIRTH DATE	AICA REG. NO.	BRED & OWNED
ANIMAL NAME	BIRTH DATE	AICA REG. NO.	BRED & OWNED
ANIMAL NAME	BIRTH DATE	AICA REG. NO.	BRED & OWNED
ANIMAL NAME	BIRTH DATE	AICA REG. NO.	BRED & OWNED
ANIMAL NAME	BIRTH DATE	AICA REG. NO.	BRED & OWNED
ANIMAL NAME	BIRTH DATE	AICA REG. NO.	BRED & OWNED

COW-CALF PAIRS
Entry not valid unless REGISTRATION paper is in the EXHIBITOR’S NAME by the entry deadline.
If your cow/calf entry will be shown in the Bred & Owned Show ($10 entry fee required), you must place a check mark in the box, following the cow’s AICA Reg. No. Bred & Owned cow/calf pairs are not automatically entered in the Bred & Owned Show, but must be entered in the “Owned Show” to be eligible for the Bred & Owned Show.

DAM NAME	BIRTH DATE	AICA REG. NO.	BRED & OWNED
CALF NAME	BIRTH DATE	AICA REG. NO.
DAM NAME	BIRTH DATE	AICA REG. NO.	BRED & OWNED
CALF NAME	BIRTH DATE	AICA REG. NO.
DAM NAME	BIRTH DATE	AICA REG. NO.	BRED & OWNED
CALF NAME	BIRTH DATE	AICA REG. NO.

BRED & OWNED BULLS • Calved after January 1, 2010
Must be bred & owned by exhibitor. Exhibitor must be at least 12 by May 20, 2011.

ANIMAL NAME		BIRTH DATE		AICA REG. NO.
ANIMAL NAME		BIRTH DATE		AICA REG. NO.

PERCENTAGE HEIFERS • Calved after September 1, 2009
Entry not valid unless RECORDATION paper is in the EXHIBITOR’S NAME by the entry deadline.

ANIMAL NAME		BIRTH DATE		AICA REG. NO.
ANIMAL NAME		BIRTH DATE		AICA REG. NO.

STEERS

IDENTIFICATION NUMBER (for record-keeping purposes only)
IDENTIFICATION NUMBER (for record-keeping purposes only)

Entry form will not be processed if you are not a member of AIJCA and/or if your 2011 AIJCA dues have not been paid. Do not include your initial membership fee or your dues payment in your entry fees! Membership fees and dues payment can only be paid by CHECK and must be made payable to AICA.

Contest Entries
Please check the boxes you will be participating in.
Participants are responsible to know and follow all contest rules. Click the link on the Junior National Home page – Junior National Contests to review the complete set of rules for each contest.

Individual Competitions

	Resume & Interview Contest
	Prepared Speech Contest
	Impromptu Speech Contest
	Poster Contest
	Photo Contest
	Talent Contest
	Art Contest

Team Competitions

	Cook-off Contest
	Quiz Bowl Contest
	Skit Contest
	Team Fitting Contest
If you would like to participate in team competition(s) but will not have enough members, indicate which contests:

Additional

Mentorship Program (Any Junior running for Area Director is required to participate)

Authorization For Emergency Care To Minors (Under 18)
To be completed by parent or legal guardian.

COMPLETE EVEN IF PARENT/LEGAL GUARDIAN WILL BE IN ATTENDANCE AT JUNIOR NATIONAL: I, the undersigned parent or legal guardian of the minor listed on reverse side, do hereby authorize any X-ray, examination, anesthetic, dental, medical or surgical diagnosis or treatment by any physician or dentist licensed by the state and hospital service that may be rendered to said minor under the general, specific or special consent of: name of adult person who is temporary custodian of minor_ _The temporary custodian of the minor(s); whether such diagnosis or treatment is rendered at the office of the physician or dentist, or at a hospital licensed by the state, I authorize the physician or dentist to call in any necessary consultant at his discretion. I further authorize said physician or dentist to exercise his discretion in authorizing the disposal of any severed tissue or member. It is understood that this consent is given in advance of any specific diagnosis or treatment being required, but is given to encourage the temporary custodian of the minor(s), and said physician or dentist to exercise their best judgement as to the requirements of such diagnosis or medical or dental treatment.

List Known Allergies of Minor:

This consent shall remain effective until Midnight on July 2, 2011, unless sooner resolved in writing, delivered to said physician or dentist or said person instructed with the custody, care and control of said minor child or children. By checking this box, I consent to the above (must be checked by parent or legal guardian):
(Checked by parent or legal guardian)

In case of emergency, please provide phone numbers of people who should be contacted:

Name:

Relationship:

Phone Number:

Liability Release
To be completed by all participants (junior and adult)

I verify that I have read the rules, regulations, and Agreement of Responsibility and Liability, related to participating and exhibition in the American-International Junior Charolais Association Junior National event and agree to adhere to all the rules and regulations accordingly. (Must be signed by both the junior participant and parent or guardian; and all adult participants before entries will be processed).

Junior Participant: I have read and understand the above statement:

Parent or Guardian/Adult Participant: I have read and understand the above statement:

T-Shirt Sizes
Indicate sizes below.

One Free T-shirt per Junior National registered participant - junior and adult. Indicate T-shirt size below (adult sizes only).
If you order an extra T-shirt(s), also indicate size(s) below. Extra t-shirt is $15 before May 10 and $25 May 11-20.

XXL

XXXL

Registration & Other Fees
No refunds.

Animal entry fees are automatically calculated based on the entries completed above.
In order to adjust the fees, clear or add animal entries in the appropriate animal categories.

On or before May 10

SHOWMANSHIP		@ $10
OWNED HEIFER ENTRIES		@ $65
BRED & OWNED HEIFER ENTRIES		@ $10
OWNED COW/CALF ENTRIES		@ $65
BRED & OWNED COW/CALF ENTRIES		@ $10
PERCENTAGE HEIFER ENTRIES		@ $65
BRED & OWNED BULL ENTRIES		@ $75
STEER ENTRIES		@ $75
8X10 GROUP PHOTO		@ $10
EXTRA AWARDS BANQUET TICKETS		@ $25
SLIDE SHOW ON CD		@ $15
LEADERSHIP CONFERENCE & MEAL TICKET		@ $50
T-SHIRT(S) (1st is free)		@ $15

On or before May 20

SHOWMANSHIP		@ $20
OWNED HEIFER ENTRIES		@ $75
BRED & OWNED HEIFER ENTRIES		@ $20
OWNED COW/CALF ENTRIES		@ $75
BRED & OWNED COW/CALF ENTRIES		@ $20
PERCENTAGE HEIFER ENTRIES		@ $75
BRED & OWNED BULL ENTRIES		@ $85
STEER ENTRIES		@ $85
8X10 GROUP PHOTO		@ $20
EXTRA AWARDS BANQUET TICKETS		@ $35
SLIDE SHOW ON CD		@ $25
LEADERSHIP CONFERENCE & MEAL TICKET		@ $60
T-SHIRT(S) (1st is free)		@ $25

You must register for the Leadership Conference/Meal ticket to be able to show.

see explanation below.

Pay By Credit Card

* Pay By Check

TOTAL ENTRY, CONFERENCE REGISTRATION & OTHER FEES: $

* Entry will not be processed until payment is recieved in the AICA office. If paying by check must be postmarked by May 10th for the first deadline and May 20th by the second deadline.

Leadership Conference:
All juniors must register for the Conference to participate in any other events, including the AIJCA National Show. The Conference registration fee includes all conference meals and banquet tickets for juniors and adults—this is your most economical choice!
NOTE: Checks for membership fees and annual dues payments must be made payble to AICA.
Make Entry, Conference Registration and other fees Check Payable To AIJCA

Click submit only once, double clicking could result in double charges on the credit card!



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A m e r i c a n - I n t e r n a t i o n a l C h a r o l a i s A s s o c i a t i o n
With more than 2,900 active members, the AICA is one of the most dynamic and innovative breed organizations in the country! Members are eligible to participate in a variety of livestock shows, industry conferences, association activities, and educational meetings. The AICA is the official registry of Charolais and Charbray cattle in the United States. In 2007, the AICA had 64,000 active females reported. Active and Junior members contact AICA for a password to use the “Register Online” system.