Please enable JavaScript in your browser to complete this form.Prince Edward Island Lady Slipper/Joe O’Brien Stakes Broodmare Declaration FormFor broodmares, whose owners reside outside Prince Edward Island and who were on Prince Edward Island for a minimum of 183 days in the foaling year and whose offspring are being nominated to the Lady Slipper/Joe O’Brien Stakes. Nominations are subject to the terms and conditions of the Lady Slipper/Joe O’Brien Stakes as approved by the Atlantic Provinces Harness Racing Commission. The deadline to submit this form will be December 1st, 2024.Information pertaining to the broodmare(s) who resided on Prince Edward Island for a minimum of 183 days during the year 2024:Broodmare *Owner *Province *Telephone # *BroodmareOwnerProvinceTelephone #BroodmareOwnerProvinceTelephone #BroodmareOwnerProvinceTelephone #BroodmareOwnerProvinceTelephone #BroodmareOwnerProvinceTelephone #BroodmareOwnerProvinceTelephone #BroodmareOwnerProvinceTelephone #Information pertaining to the farm/property where the above broodmare(s) resided for a minimum of 183 days in the Province of Prince Edward Island in 2024.Farm/Property Owner/ManagerPhoneEmail *AddressAddress Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountry DeclarationC A N A D A PROVINCE OF PRINCE EDWARD ISLAND IN THE MATTER OF: The Prince Edward Island Lady Slipper/Joe O’Brien Stakes. I, (Typed Name Below), of (Address above), in the Province of Prince Edward Island, Farm/Property Owner/Manager do solemnly declare that: 1. I am the person who owns or did own/manage the farm/property on which the broodmare(s) described in the Broodmare Declaration Form (reverse) resided during the last calendar year. 2. The matter and facts in the Broodmare Declaration Form are true, to my own knowledge; and 3. I understand in the case of information in the Broodmare Declaration Form not being correct that the mare described therein would be declared ineligible for the Prince Edward Island Lady Slipper/Joe O’Brien Stakes and my farm/property or I would be liable to reimburse all purse money earned by the farm, myself or the buyer of the applicable offspring and my farm or I would be ineligible to participate in the Prince Edward Island Lady Slipper/Joe O’Brien Stakes in the future. And I make this solemn declaration conscientiously believing it to be true and knowing that it is of same force and effect as if made under oath. County of Canada, Prince Edward Island,) Name and Signature of Farm/Property Owner/Manager Farm Manager Sign HereClear SignatureBy typing your name above, you agree to the terms and conditions of the declaration.Submit Resident Mare Program Download Form Broodmare Declaration Form Ladyslipper O'Brien 2022 by Julie Jamieson on Scribd