TELEPHONE ACCOUNT BETTING APPLICATION

First Name:_________________________________________ Initial:____________

Last Name:____________________________________________________________

Street Address:_________________________________________________________

City:______________________________ Postal Code:_________________________

Province:______________________________________________________________
(must be Alberta or Northwest Territories)

Phone:________________________________________________________________

Amount of Deposit:_____________________________________________________
($50.00 minimum - money order or certified cheque)

Code Name desired (select three names in order of preference)

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

I certify that the information given in this application is correct, and I am 18 years of age or older. I have attached a copy of my drivers license or other ID showing age and residence. I hereby give consent to have all telephone betting transactions tape recorded by Stampede Park and monitored by the Canadian Pari Mutuel Agency.

I further certify that I have read the conditions covering my application, and that failure on my part to conform to any part of the conditions shall result in my account being closed and my remaining deposit refunded.

Signature:____________________________________________________________

Please mail this application along with deposit, proof of residence and age to:

Pari Mutuel Manager
Stampede Park
P.O. Box 1060
Calgary, AB T2P 2K8

Once your application is received, you will be notified with your account number and code name.