Opening Date: May 23, 2016 Closing Date: June 7, … Date: May 23, 2016 Closing Date: June 7, 2016 Class List: Every class offered herein which is covered by the rules and …

Opening Date: May 23, 2016

Closing Date: June 7, 2016

Dressage at Red Tail farm I1100 Rattlesnake Bridge Road

Bedminster, NJ 07921USEF/USDF #333302 — Level 2

June 18, 2016

2016 Great American Insurance Group/USDf Qualifiing Event

2016 Col. Bengt Ljunquist Memorial Championship (BLM) Qualifying Event

2016 ESDCTA Recognized

Manager: Secretary: Judges:

Amy Gimbel Amy Gimbel Joanne Crilly, Canada, (5)

908.310.5541 (cell) 908.310.5541 (cell) Joanne Bouwhuis, Canada (5)

[email protected] [email protected] TBD

Show Office Phone: Online Entries: Technical Delegate:

908439.3345 https://www.equestria nentries.com Dorothy Maxfield, NJ (r)

Volunteer Coordinator: Farrier: EMT:

Amy Gimbel Tom LaRose Will be on grounds, contact

908.310.5541 (cell) 907.399.3477 through the show office

[email protected] Dave Vanderhoof

201.787.1363

Licensee: Linda C. Dietz Veterinarian:

B.W. Furlong & Associates908. 439. 2821— on call



Class List:

Every class offered herein which is covered by the rules and specification of the current USEF Rule Book

will be conducted and judged in accordance therewith.

Please denote on entry Open, CBLMQ, USDE GAIG Q and status of Amateur, Open or Jr/YR.

Management reserves the right to split, cancel, combine classes, or substitute judges. GAIG classes are

qualifiers for 2016! If entering as GAIG Qualifying class please indicate on entry and include the $10

Qualifying fee.

The shows fill quickly and entries will be process on first come basis.

Class U Fee Level Test Qualifications

1 $35 USDF Introductory TOC

101 $35 TrainingLevel Testi Open

102 $35 Training Level Test 2 Open/CBLM Q

103 $35 Training Level Test 3 Open/USDF GAIG Q

104 $35 Training Level Test 1 Opportunity

111 $45 FirstLevel Test; Open

112 $45 First Level Test 2 Open/CBLM Q

113 $45 First Level Test 3 Open/USDF GAIG 0

114 $45 First Level Test 1 Opportunity

121 $45 SecondLevel Test; Open

122 $45 Second Level Test2 Open/CBLMQ

123 $45 Second Level Test 3 Open/USDF GAIG 0

124 $45 Second Level Test3 DoverMeUaIAAUSDFGAIGQ

131 $45 Third Level Test 1 Open

132 $45 Third Level Test2 Open/CBLMQ

133 $45 Third Level Test 3 Open/USDE GAIG 0

141 $45 Fourth Level Test; Open

142 $45 Fourth Level Test2 Open/CBLMQ

143 $45 Fourth Level Test 3 Open/USDE GAIG 0

150 $55 FEI PSG Open/USDE GAIG Q/CBLM 0

151 $55 FEI Intermediare I Open/USDE GAIG QJCBLM U

152 $55 EEl Intermediare II Open/USDF GAIG QJCBLM U

153 $55 FEI Grand Prix Open/USDF GAIG QJCBLM U

154 $55 FEI TOC Open/USDFGAIGQJCBLMQ

160 $55 USDF MFS TOC Open/USDF GAIG QJCBLM U

161 $60 EEl MFS TOC Open/USDF GAIG Q/CBLM U

170 $45 FEI YHTOC Open

171 $35 Dressage Seat Equitation



Fees:

$16 Federation Fee ($8 Drug Fee plus $8 USEF Fee)

$30 Office Fee (Non Refundable)

$10 GAIG/USDF Qualifying Per Class

$30 Late Entry (After Closing Date)

$10 Secretary Verification of Documents if incomplete entry

$5 USDF Affidavit (if necessary)

$25 USDF non-member fee

$25 USDF Horse ID

$30 USEF Show Pass Fee

$40 Non-Competing Horse, must have signed entry form and negative Coggins

$10 Add/Change Class Fee

$50 Returned check Fee

Entries: Please make checks payable to Red Tail Farm. Online entries accepted via Equestrian

Entries. Illegible or incomplete entries may be returned or charged the $10 fee. Be sure to

include copies of USEF and USDF membership or identification cards for each owner, rider,

trainer and horse/pony as applicable. Emergency numbers MUST be included.

In compliance with GR 845 will require proof of Equine Influenza Virus and Equine

Herpes Virus vaccination for all horses entering the show grounds.

USDF Introductory and Opportunity classes are exempt from USEF and USDF membership requirements

and are not eligible for show high score awards.

USDF GAIG Qualifying — Eligible competitors may enter the class USDE GAIG Q for an additional fee of

$10. You MUST designate your entry as USDF GAIG Q on the entry and submit appropriate

documentation to verify eligibility to enter the class. Copies of USEF AND USDF Horse Registration (NOT

HID) must be included. Riders MUST have participating membership in USDF. Owner MUST have a

current participating or business membership in the USDF.

CBIM — Qualifying classes for the 2016 BLM Championship (cblm.org). Riders must be members of a

participating organization at the time of the show to be eligible.

Musical Freestyles — Riders MUST submit with their entry a copy of the highest test of the level entered

or higher level (with a minimum score of 60%) in accordance with USEF rules. Music must be on a good

quality CD and must be presented to the show office on day of the class.

Parking - Please notify management if you have a large rig so we can accommodate

Stabling - Not available



ATTENTION COMPETITORS: Each competitor is responsible for supplying management with the correct

applicable numbers and hard copy proof (USDF and USEF) for horse, owner, rider and trainer, before the

day(s) of the competition.

The scores of competitors who fail to supply correct numbers may not be counted toward national

awards.

Times: It is possible that the show may start as early as 7 a.m. and end as late as 8:30 p.m.

Times will be posted on foxvillage.com and check Red Tail Farm facebook and website for additional

announcements. Unofficial times will be posted 4 days before the show. Official times will be posted

noon the day prior to the show.

Late Entries: Entries will be accepted after the closing date at Managements discretion if space allows

and with appropriate late fee.

Refunds: Full refund less office fee if scratch is received before closing date. No refunds will be

provided after closing date including for cancelations due to Acts of God, acts of terrorism, inclement

weather, and/or other emergencies.

Coggins: A copy of a negative Coggins test dated within 12 months of show date must be provided

Sharps Container: Will be located in the barn for the disposal of needles and other disposable sharp

instruments. Competition management may fine any individuals including trainers, owners, exhibitors,

or their agents up to $100 for improper disposal of needles or other sharp disposable instruments.

Bridle Numbers: It is compulsory for the bridle number to be worn by the horse, competitor, or handler

at all times, when the horse is being handled or exercised.

Protective Headgear: USEF rules go into effect upon arrival at the show grounds. Per DR12O.1-6

Protective Headgear must be worn at all times when mounted (exception for FEI competitors exempt by

EEl rules. It is recommended that ALL competitors wear protective headgear.)

Awards: Ribbons awarded through sixth place

Adult Amateur High Score Ribbon awarded for each level as sponsored by Flying Change Farm

USDF/Dover Adult Amateur Medal awarded to the Adult Amateur rider in class 124 with the highest

score of 60 percent or better” in the designated class. Additionally, the rider must be either a USDF

Participating or Group member to be eligible for this award

Footing: Arena Works Gold Plus footing in Indoor arena 180 x 90 (warm up), Arena Works Gold Plus

footing in standard competition arena (20m x 60m), and lunging pad with Arena Works Gold Plus

footing.

Professional Services: Contact numbers will be posted the day of the show at the show office. EMT will

be on grounds. Vet and Earner will be on call.



Hold Harmless Clause: Understanding that horse sports may be hazardous and dangerous, even leading

to permanent injury or death, each owner, rider, spectator, and other participant assumes any and all

risk of loss or injury and agrees to hold harmless, regardless of negligent acts or omissions, Red Tail Farm

LLC/Linda D LLC, the show management, show committee, and all horse show personnel.

Directions: 1100 Rattlesnake Bridge Rd. Bedminster, NJ 07921

Food/Refreshments: Will be available on show grounds for purchase

We love dogs, but please leave them at home. No dogs allowed.

Membership Statement

Life, senior active and junior active members shall be eligible to participate in all classes at Regular

Competitions, Eventing Competitions at the Preliminary Level or above and Combined Driving

Competitions at the Advanced Level, Dressage, Reining and Vaulting Competitions and Endurance

Rides. A nonmember may participate as a handler, rider, driver, owner, lessee, agent, coach or trainer

at Regular Competitions, Eventing Competitions, Dressage Competitions, Reining Competitions and

Combined Driving Competitions upon payment of a $30 Show Pass fee. Participants in the

following classes are exempted from the Requirements of this rule: 1) leadline; 2) exhibitions; 3)

games and races; 4) classes for 4-H members; 5) walk trot and academy classes (academy classes

are classes limited to horses used regularly in a lesson program); 6) USDF introductory level tests,

pas de deux and quadrille classes; 7) NRHA Endorsed Reining Competitions. 8) Opportunity

classes, 9) citizens of other nations who have proof, in English, of current membership in good

standing of their own National Federation, 10) USEA beginner novice division; and 11) assistant

handlers in Dressage Sport Horse Breeding classes.

Motor Vehicle Statement

Minors who do not have a valid driver’s license which allows them to operate a motorized vehicle in the

state in which they reside will not be permitted to operate a motorized vehicle of any kind including, but

not limited to, golf carts, motorcycles, scooters, or farm utility vehicles on the competition grounds of

licensed competitions. Minors who have a valid temporary license may operate the above described

motorized vehicles as long as they are accompanied by an adult with a valid driver’s license. Violations

of this rule will be cause for sanctions against the parent(s), guardian(s) and/or trainer(s) who are

responsible for the child committing the offense. Penalties may include exclusion of the child, parent(s),

guardian(s), and/or trainer(s) from the competition grounds for the remainder of the competition and

charges being tiled against any of the above individuals in accordance with Rule 6. Wheelchairs and

other mobility assistance devices for individuals with disabilities are exempt from this rule.



USDF Statement on Animal WelfareThe United States Dressae Federation. Inc. lCSDf. a federation of over 100 independent orranizations throughout the Uitited States with a member

ship of nearly 30M00 members, supports the concept of ethical treatment of annuals.

Dressage is a classical method of traininr horses, based upon the horse’s natural responses. as carried out in a gradual, planned prorram during which

the horse’s athletic ahilitie are improved in a systematic manner. As a result, the horse becomes capable, comfortable, and responsive in partnership

with the rider without the use of force. Dressaga competition at various levels of achievement is the ultimate test of the frainiur program to determine

whether the desired harmony between horse and rider has been achieved.

The rules pertaininr to dressage competition prohibit the use of artificial appliances. training aids, and drurs. which would force the horse to submit.

Instead, the emphasis is upon traininr and a cooperative partnership with the rider. Major competitions are carefully monitored to assure that there is

no unnecessary force or harshness displayed.

Unlike other horse sports in which horses enter training at a relatively immature state. dressae training is usually not erioush begun until the horse

is three or four. The top levels of achievement require five or more years of proessive training and it is not unusual to see horses in international

competition in their late teens. This, in itself, places a premium on good care and soundness throughout the horse’s life.

While supportiur the concept of animal welfare in its broadest form, the United States Dresare Federation, Inc.. also recoruizes that it is unrealistic to

ascribe human emotions and responses to the horse which in its wild state is a creature of flirht. living a hard and precarious existence. Under domes

tication, the horse is assured of ample food, water, and shelter, as well as protection against infectious diseases and damazing parasites, thus leading a

longer and healthier life with a high rate of survival.

As an educational organization, USDF has numerous pronls. which teach people how to pursue the accepted. humane training methods. A program

of certifying instructors also emphasizes protectine the horse’s welfare in pursuit of dressage training.



prnbersh)pyieflts: USD1 is dedicated to education, the recognition of achievement, and promotion of dressage. For details

on member benefits including educational programs, awards. and other opportunities, refer to the USDF Member Guide or The USD1 is reognized

website at www.usdf.org. b USDF

Membership ReQuirements for USEF4icensed)UBDF-recognled Competitions: Owners and nders, including foreign riders andfor 2016

owners viSa are not residents of the US, ‘wishing to partcipate in a USEF-licensed/IJSDF-tecognized competition as a ndet or

owner/lessee, must have either a USD1 Group Membership (GM). Participating Membership (PM), or have a USD1 Non-Member (NM) identification number and pay

the USD1 Non-Member (NM) fee. (Note: USD1 Business Members can own horses but cannot compete as riders with their USD1 Business Membership.)

Individuals cannot compete at a USEF-licensediUSDl-recognized competition with a USD1 Education Membership.

Horses competing at USEF.hcensediUSDl-recognized competitions must have either a USD1 Horse Identification (HID) number or a USD1 lifetime Horse

Registration (LHR) Proper credentials or •;erification certificates must be presented to the competition secretary.

Riders and owners wishing to participate in a USE1-licensedlUSDl-recognized competition, and not able to present the competition secretary with ‘verification of a

USD1 membership or NM identification, and USD1 LHR or USD1 HID, must complete a USD1 Competition Affidavit Form and pay the $5 affidavit tiling fee. A copy

of a completed affidavit form from another competition may also be used for ‘.‘enflcation purposes for up to 60 days. (Exception. Affidavits cannot be used at Great

Amencan Insurance GroupllJSDF Regional Dressage Championships)

Exceptions:Homes competing onty in Individual Breed Classes (IBC5) at DSHB competitions, sires and dams of homes in DSHB group classes, where those sires or

dams are not actually competing in the same competition, horses competing onty in breed restricted dressage or DSHB classes at Regular Competitions

ie.g all Arabian, all Iriesian. or all Moran classes), or in USD1 Introductory Level tests, pas de deux or quadrille, are exempt from this requirement. Also

exempt are homes ndden in leadline. exhibitions, games and races, classes for 4-H members, walk-trot, academy and opportunity classes.

Riders and owners/lessees competing only in classes which are exempt from the USD1 HID requirements are also exempt from the USD1 NM

identification number and NM fee requirements Also exempt are handlers of horses competing in D$HB In-Hand or Group classes.

Memberships Defined

Participating Membership tPM): A membership issued to an individual directly by USD1. The membership year is December 1 through November 30 PMs are

available for 1-year ($75), 5-years ($300). or life iSl.500). A USDF Youth Participating Membership (YPM) is available for individuals who have not reached their 21’

birthday by December 1 of the current membership year ($60). A PM allows the member to compete at USEF-licensed?USDF-recpgnized competitions and to

participate as a nder and/or owner/lessee for all Adequane/USDF Year-End Awards, Great American Insurance Group/USDI Breeders Championship Series Finals

and the Great American Insurance Gmup/USDF Regional Dressage Championship program

Group Membership (GM): A membership issued to an individual by USD1 when the member name and dues are submitted to USD1 through an affiliate Group

Member Organizahon IGMO). The GM year begins December 1 and ends November 30. A GM allows the member to compete at USEI-Iicensed/USDF-recognized

competilrons and particinate in the USD1 Rider Awards program

Business Membership (BU): A membership that runs December 1 through November 30 and is issued to a business or organization directly by U.SDF The USD1

BM ($200) otters a wider vanety of advertising benefits. BMs satisfy requirements of home ownership only

Education Membership (EM): A membersb-ip issued to an individual directly by USOF. This online education only membership expires 12 months after the dale

joir.ed This membership type does NOT allow an individual to compete at a USEF-licensed/USOF-recognized competition.

Non-Member (NM) Identification Number: For each USD1 NM owner/lessee and USD1 NM rider there ‘will be a USD1 NM fee of $25 per competition that must be

collecfed by the show secretary and subm:tted to USD1, along with the USD1 Report of Fees document and the $5 affidavit fee and Competition Affidavit Form if the

person cannot provide a copy of Iheir USD1 NM card. Owners/lessees or riders exempt from the NM number requirements are also exempt from paying the USD1

NM fee. If there are multiple owners of a home and all are NMs. only one of the owners must pay the NM fee. If the horse has at least one owner who is a current

USD1 PM. GM or SM there is no NM fee assessed Competition management will b€ invoiced for all applicable USDF NM tees not received with the USDF post

competition paperwork, along with a report listing all USDF NMs Competition management is then required to submit the NM fees within 30 days to the USD1. An

individual with a USD1 NM identification number is not eligible for any USD1 membership benefits Once a USD1 NM number has been assigned, a USD1 NM card

can be obtained ftom the USUF website.Horse Identification (HID) Number: A one-time tracking number for horses I$25). Scores earned by a horse with an HID number will be recorded, but will NOT be

counted towards Adequan’HUSDF Year-End Awards. A horse with an HID number is not eligible to compete in Great American Insurance GroupIUSDF Regional

qualifying or championship classes or Great Amencan Insurance Group/USDF Breeders Championship Senes Finals, An HID number can be upgraded to a Lifetime

Horse Registration (LHR) for a fee of $70. If a horse has a USDF [HR it does not need an HID number. An HID number is a one-time fee that does not need to be

renewed.Lifetime Horse Regitratton (LHR): A home with an [HR ($95) is eligible for Adequane/USDE Year-End Awards. and eligible to compete at Great Ansincan

Insurance GroupJUSDF Breeders Championship Series Finals and Great American Insurance Group/USDE Regional qualifying and championship classes, assuming

requirements for fire owner and nder are met If a home has an [HR it does not need an HID number. An LHR does not need to be renewed.

How to Join USDF

Applications for USD1 Participating Membership (PM), Business Membership (BM). Home Identification (HID) number, and Lifetime Home Registration (LUR) may

be found in the following locations• On the USD1 web-site: www.usdt.org. You can submit the application online or download the form and fax or mail it to the USD1 office

• In the show office at USEF-licensed’USDF-reccgnized competitions classified by USEF as Dressage Competitions. and Regular Competitions ‘which are

open to all breeds• By calling or wnting the USD1 office at (859)971-2277, 4051 Iron Works Parkway. Lexington, KY 40511

The effective date of membership is the date the form and correct fees are received in the USOF office or, if applying at a competition, the date accepted by the

competition secretary, provided the application is signed and dated by the competition secretary. member, and/or horse owner on that same day.

2016 USDF/Dover Saddlery Adult Amateur Medal Program

The USDf/Dover Saddlery Adult Amateur Medal Program is designed to specificallyrecognize and encourage adult amateurs riding at Second Level.

Awards1. USDF/Dover $addlery Medal Recipient

The eligible rider with the highest score of 60 percent or better in the designatedSecond Level Test Three class or applicable test of choice USDf/Dover SaddleryAdult Amateur Medal class at a participating competition will receive a handcraftedUSDF/Dover Saddlery pewter medal and neck ribbon. Winners will receive a $20Dover Saddlery gift certificate for the first three USDf/Dover Saddlery Medals theywin during the competition season.

2. USDF/Dover Saddlery National Merit AwardA USDf/Dover Saddlery National Merit Award will be awarded to riders winningthree USDF/Dover Saddlery Medals in the same competition year.

3. Year-End AwardsThe USDF/Dover Saddlery Medal National Champion and Reserve Champion aredetermined from the average of the top three winning ride scores during thecompetition year. The champion receives a $1000 Dover Saddlery gift certificate andthe reserve champion receives a $500 Dover Saddlery gift certificate.

Rider Eligibility1. Rider must have a current USDF Participating or Group Membership and be a

member in good standing of USDF when the scores are earned.2. Rider must be an adult amateur in accordance with Article GR1306 of the USEF

rules and be designated with USEF as an adult amateur at the time the scores areearned.

Owner & Horse Eligibility1. Horse and owner must meet minimum competition eligibility requirements at the

time scores are earned.

Additional InformationFor additional information and an updated list of competitions offering the USDF/DoverSaddlery Adult Amateur Medal Program, please visithttp://www.usdf.org/awards/performance/adultmedalprogram.asp.

Competitions/rev. 5/7/2015

GREATAM)tNtUH4 GROUP

AusowREGIONAI

I)?e36aqeCHAMPION41PS

Training Level (Test 3)

First Level (Test 3)

Second Level (Test 3)

Third Level (Test 3)

Fourth Level (Test 3)

FEI Junior (Team lest)

FEI Young Rider (Team Test)

Prix St. Georges

Intermediate I

Intermediate II

Grand Prix

FREESTYLE

First Level

Second Level

Third Level

Fourth Level

Intermediate I

Grand Prix

OPEN68%66%64%62%62%

60%60%60%60%

AA63%62%61%60%60%

60%60%60%60%

AA

JR/YR

63%62%61%60%60%60%60%60%60%

60%60%

JR/YR

2016 Great American Insurance Group/USDF Regional Dressage

Championships

A single Regional Dressage Championship program organized by the United States Dressage Federation (USDE),

and recognized by the United States Equestrian Federation, Inc. (USEF), will be held in each of the nine USDF

regions. In addition, Alaska and Hawaii may each hold state championships if an official request from a Group

Member Organization (GMO) is received by April 1 of the prior year. The Regional Championship Program Rules

can be found on the USDE website at www.usdf.org. Please refer to the 2016 USDF Member Guide for the

comprehensive list of rules and requirements for this program.

Membership/Registration Requirements for Qualifying and Championships

Rider:

• Must have a USDF Participating* Membership (PM) at the time qualifying scores are earned and at the time of the

championships.

• Must have a USEF membership (Junior Active, Senior Active, or Life) at the time the qualifying scores are earned and at the

time of the championships.

Horse:

• Must have a USDF Lifetime Horse Registration (LHR) at the time qualifying scores are earned and at the time of the

championships.

• Must have a USEF (Annual or Lifetime) Membership recorded at the time qualifying scores are earned and at the time of

the championships.

• USDE horse registration and USEF horse/recording must be in the name(s) of the current owner(s) or lessee(s) of record.

• A horse is not required to have breed registry papers.

Owner:

• Must have a USDF membership (PM* or Business Member (BM)) at the time the qualifying scores are earned and at the

time of the championships.

• Must have a USEF membership (Junior Active, Senior Active, or Life) at the time qualifying scores are earned and at the time

of the championships.* PMs are USDF members who join USDF directly. USDF Group Members (GM) are ineligible.

Minimum Qualifying Scores. One set of nationally-standardized qualifying scores has been established for all USEF/USDF Regional

Championships, for levels through Grand Prix, in three divisions: open, adult amateur and junior/young rider. FEI Junior and FEI

Young Rider classes have only one respective division. Freestyles have only open divisions.

The minimum percentages are as follows:

OPEN

63%63%63%63%63%63%

Rev May 2015

2016 DRESSA GE COMPETITION ENTRY FORMEffective December 1, 2015, use this form for entering USEFIUSDE Licensed Dressage

Competitions held in USDF Region 1 (PA, NJ, DE, MD, VA, NC, WV)

Competitors are responsible for duplicating their own additional copies of this entry form. This is a 2-sided

form; please make 2-sided copies. Other versions of entry forms may not be accepted by Region 1

competitions. TYPE OR PRINT CLEARLY -- ONLY ONE HORSE I RIDER or HANDLER PER ENTRY FORM

Enclose copy of all 2076 USEF Membership Cards (Rider/Handler, Owner/Agent, Trainer, Coach) or verification.

Competition Name:

______________________________________________

Competition Date(s):

All USEF members (including riders, handlers, trainers, coaches, owners, agents or lessees) are required to

submit proper membership documentation to the show secretary prior to competina. Exhibitors who do not

send a copy of their card with their entry or are unable to produce the card when registering at the

competition, or for whom the competition cannot verify such information (with the exception of Federation

measurement cards) will be required to pay a $30 Show Pass fee which is non-refundable.

EACH Junior and Senior participant (rider, handler, trainer, coach and one owner/agent per horse) is required

to be a USEF Active Competing” Member or pay a $30 Show Pass fee (see the official USEF Show Pass

Statement in prize list).Non-U.S. citizen participants in DressagelDSHo classes MUST attach current proof, in English, of current

in qood standing in their own N.F in order to be exempt from USEF Show Pass fees.

Payment For Fee Office Use

Subtotal, Class Fees

USEF Show Pass/Non-MemberFee(s) ($30 per participant)USE Fee per horse:(D&M $8÷ USEF $8) $16CDI horses only: USEF Fee perhorse: (D&M $20 + USEF $8) = $28CDIs only: USEF IHP Discipline Fee($35 per entry)Stabling / Grounds Fee (For Non-Stabled Horses)USDF Non-Member Fee(s)($25 per rider/owner)

Office Fee

Late Fee, Bridle Number Fee,Camper Fee

Other Fee(s)

TOTAL FEES DUE:

Official Use Only Bridle No,

Rider/Handler:

____________________________________

Primary Phone:

________________Alternate

Phone:

________________

Rider’s Address:

Rider/Handler E-Mail:

______________________

Owner: Primary Phone:

Owner’s Address:

________________________________________

Trainer: Trainees Addres:

Coach:

_________________________________

Trainer’s Phone during Competition:

Citizenship*:

Alternate Phone:

uu-#

E-Mail:

UEI-

USQF#

— LOCAL ASSN#

HORSE RIDERIHANDLER OWNER (At least one) TRAINER COACH (if applicable)

USDF#

Uihb# U3EI-#

Unless show provides en fry verification service:

MUST attach copies of USEF & USDF Horse Recording

and Registration Certificates for CAIG/USDF Qualifying

and Championship Classes.* MUST include a copy of USEF Amateur Certification if

competing as an Adult Amateur.Go to I oral to print

—

SUBTOTAL Class Fees

JR or YR Birthdate:

________________________

Riders are eligible to compete as

a JrIYR until the end of the calendar year in which they reach the age of 21

i]IL..]’g.’],lI.p]51.l.]

Rider: Citizenship: FEI Rider Registration #: Competing for Country:

Horse: Present Nationality: Birthdate: Previous Name (if any):

EEl Passport #: EEl Horse Registration #: Person Responsible:

Owner: Citizenship: Owner Social Security or Tax ID # (required to receive prize money):

US Equestrian Federation, Inc. Entry Agreement I have read the United States Equestrian Federation, Inc. (the “Federation”)Entry Agreement (GR906.4) as printed in the Prize List for [insert name here] (“Competition”) and agree to all of its provisions. Iunderstand and agree that by entering this Competition, I am subject to Federation Rules, the Prize List, and local rules of thecompetition. I agree to waive the right to the use of my photos from the competition, and agree that any actions against theFederation must be brought in New York State.Federation Release, Assumption of Risk, Waiver and Indemnification This document waives important legal rights.Read it carefully before signing. I AGREE in consideration for my participation in this Competition to the following: I AGREEthat “the Federation” and “Competition” as used herein includes the Licensee and Competition Management, as well as all oftheir officials, officers, directors, employees, agents, personnel, volunteers and Federation affiliates. I AGREE that I choose toparticipate voluntarily in the Competition with my horse, as a rider, driver, handler, vaulter, longeur, lessee, owner, agent,coach, trainer, or as parent or guardian of a junior exhibitor. I am fully aware and acknowledge that horse sports and theCompetition involve inherent dangerous risks of accident, loss, and serious bodily injury including broken bones, headinjuries, trauma, pain, suffering, or death. (“Harm”). I AGREE to hold harmless and release the Federation and the Competitionfrom all claims for money damages or otherwise for any Harm to me or my horse and for any Harm of any nature caused by meor my horse to others, even if the Harm arises or results, directly or indirectly, from the negligence of the Federation or theCompetition. I AGREE to expressly assume all risks of Harm to me or my horse, including Harm resulting from the negligenceof the Federation or the Competition. I AGREE to indemnify (that is, to pay any losses, damages, or costs incurred by) theFederation and the Competition and to hold them harmless with respect to claims for Harm to me or my horse, and for claimsmade by others for any Harm caused by me or my horse while at the Competition. I have read the Federation Rules aboutprotective equipment, including GR8OI and, if applicable, EVII4, and I understand that I am entitled to wear protectiveequipment without penalty, and I acknowledge that the Federation strongly encourages me to do so while WARNING that noprotective equipment can guard against all injuries. If I am a parent or guardian of a junior exhibitor, I consent to the child’sparticipation and AGREE to all of the above provisions and AGREE to assume all of the obligations of this Release on thechild’s behalf. I represent that I have the requisite training, coaching and abilities to safely compete in this competition. IAGREE that if I am injured at this competition, the medical personnel treating my injuries may provide information on my injuryand treatment to the Federation on the official USEF accidenUinjury report form. BY SIGNING BELOW, I AGREE to be bound byall applicable Federation Rules and all terms and provisions of this entry blank and all terms and provisions of this Prize List. IfI am signing and submifting this Agreement electronically, I acknowledge that my electronic signature shall have the samevalidity, force and effect as if I affixed my signature by my own hand. BOD 1/23/11 Effective 12/1/11

li]:I’]Ilfl7r.nrw) nI1TlTlILtt1*iI(flTflriT&)Signature: Signature: Signature (must be 18 or older): Signature:

Print:

1int:

Print:

Lint:

u1iiwLIutl.1Tuit(.r .

Signature: Print:YES NO

* No entry is valid without original signatures from the above individuals; Photocopied signatures or writing ‘same” are NOT acceptable.

Stall Sex Check Stall DayslNights Desired (see prize list directives)

Occupant (S,M,G) Mon Tues Wed Thurs Fri Sat Sun

Horse Name

If accompanied by NON-COMPETING HORSE, must complete separate entry form and pay all applicable fees.

Tack In/al I I I I I

PLEASE SUBMIT ANY IMPORTANT INFORMATION FOR THE ANNOUNCER ON A SEPARATE SHEET

Contact NAME and NUMBER for Rider Emergency:

STABLING I CAMPER HOOK-UP RESERVATION FORM (Refer to Prize List for Specifications)

Contact NAME and NUMBER for Horse Emergency:

Name of Lodgings Where Rider or Responsible PartyWill be Staying During the Competition

ENTRY PREPARATION CHECKLIST

Hotel Number at the Competition(For Emergency Contact Purposes)

Approx. Time of Arrival:

Special Requests”:

Approx. Time of Departure:

Before Mailing, Be Sure You Have:

..........Completed Both Sides of Entry Form

..........All Original Required SignaturesEnclosed a Copy of the CurrentNegative Coggins (EIA) Certificate (Referto Show Specifications for Date ValidityRequirements. Copy must be legible.)

..........Supphed all Required Ass’n Numbers

........Enclosed Copies of Applicable USEFand/or USDF Cards or DocumentsCompleted the Stabling I Camper

..........Enclosed a Check! Money Order forall Applicable Fees.

..........Allached photocopy of Test(s) verifyingUSDF & EEl Freestyle Test eligibility(ex. for exempt classes)Mail this Entry Form, Supplemental

Documents, and Fees to theCompetition (Entry) Secretary Identified

on the Prize List.EMERGENCY CELL CONTACT # OF

SOMEONE WITH YOU/YOUR GROUPAT THIS SHOW WHO IS NOT LIS TEDELSEWHERE ON THIS ENTRY FORM

*provjde name of individual with whom you desire to be stabled (if part of a group, make sure you all name the same person)

Stabling fees:

___________stalls

for

___________nights

@ $

_________

per night =

__________________

Camper fees ..hook-ups $ ea (flat rate) OR ..nights § $

_______

per night =

_________

TOTAL STABLING I CAMPER HOOK-UP FEES:

USEF Competition NameCompetition Division(s) and Ratinqs:

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