USEF/USDF #3385 C D E L 3 C A 23, 2018

M 11—13, 2018 D S P H T ,

P , NC Official Qualifying Competition for the 2018 Adequan FEI North American Junior and Young Rider

Championships presented by Gotham North; The 2018 Children Dressage National Championship; 2018 USEF Pony Rider Dressage National Championship; 2018 AGCO/USEF Junior and Young Rider Dressage National Championships, and the 2018 USEF Young Adult ‘Brentina Cup’ Dressage National Champion-

ships presented by Dressage Today. Official Qualifying Competition for the 2018 Markel/USEF Young and Developing Horse Dressage Championships. Official Qualifying Competition for the 2018 FEI World

Breeding Championships for Young Horses in Dressage (Five, Six and Seven Year Olds). 2018 Great American Insurance Group/USDF Regional Qualifier, 2018 CBLM Qualifier A National Dressage Pony Cup Partner Show, NCDCTA Recognized, AQHA Approved

A S P /A T C

P L F & .

Manager/Entry Secretary Kay Whitlock 910-692-8467 Cell: 910-315-5959 PO Box 478; Southern Pines, NC 28388 kaydq@fastmail.fm Show website: www.carolinadressage.com Day Secretary Robert Belton Veterinarian Dr. Bri Gindlesperger 910-585-6053 Farrier on Call Billy Pope 910-987-2027

Judges Joan Macartney (S) Lois Yukins (S) Lisa Cox (R) TBA Technical Delegate Lisa Rogers EMT Wade Hardin 704-914-5774 Competition Management: Viewpoint Enterprises, Inc. Kay Whitlock, President show website: carolinadressage.com Online entries:equestrianentries.com

FRIDAY Entry Fee Prize $ 101 Training Level Test 1 Open $50 102 Training Level Test 2 BLM, Open $50 103 Training Level Test 3 Open, GAIG/USDF-Q $50 111 First Level Test Open $50 112 First Level Test 2 BLM, Open $50 113 First Level Test 3 Open, GAIG/USDF-Q $50 121 Second Level Test 1 Open $50 122 Second Level Test 2 BLM, Open $50 123 Second Level Test 3 Open, GAIG/USDF-Q $50 131 Third Level Test 1 Open $50 132 Third Level Test 2 BLM, Open $50 133 Third Level Test 3 Open, GAIG/USDF-Q $50 141 Fourth Level Test 1 Open $50 142 Fourth Level Test 2 BLM, Open $50 143 Fourth Level Test 3 Open, GAIG/USDF-Q $50 151 FEI Prix St. Georges Open, BLM, GAIG/USDF-Q $60 152 FEI Intermediare I Open, BLM, GAIG/USDF-Q $60 153 FEI Intermediare A/B TOC Open $60 154 FEI Intermediare II Open, BLM, GAIG/USDF–Q $60 155 FEI Grand Prix Open, BLM, GAIG/USDF-Q $60 156 Developing Horse TOC $60 161 FEI Jr RiderTeam Test NAJYRC–USEF /USDF- Q $75 162 FEI YR Team Test NAJYRC–USEF /USDF- Q $75 163 FEI Pony Team Test USEF-Q $75 165 FEI Yg Rider GP 16-25 $60 171 USDF Freestyle # * Open, BLM, GAIG/USDF-Q $75 172 FEI Freestyle TOC * Open, BLM, GAIG/USDF-Q $75 180 USEF Tr 3, 1st 3, 2nd 3, 3rd 3, 4th 3 TOC GAIG/USDF-Q $50 181 FEI ParaEquestrian TOC $60 190 Young Horse TOC $60

SATURDAY Entry Fee Prize $

200 Training Test 1 see note 1 Amateur Sweepstakes $75 $500 + 201 Training Level Test 1 Open $50 202 Training Level Test 2 BLM, Open $50 203 Training Level Test 3 GAIG/USDF-Q, Open $50 210 First Level Test 1 see note 1 Amateur Sweepstakes $75 $500 + 211 First Level Test 1 Open $50 212 First Level Test 2 BLM, Open $50 213 First Level Test 3 GAIG/USDF-Q, Open $50 220 Second Level Test 1 see note 1 Amateur Sweepstakes $75 $500 + 221 Second Level Test 1 Open $50 222 Second Level Test 2 BLM, Open $50 223 Second Level Test 3 GAIG/USDF-Q, Open $50 230 Third Level Test 1 See note 1 Amateur Sweepstakes $75 $500+ 231 Third Level Test 1 Open $50 232 Third Level Test 2 BLM, Open $50 233 Third Level Test 3 GAIG/USDF-Q, Open $50 240 Fourth Level Test 1 see note 1 Amateur Sweepstakes $75 $500+ 241 Fourth Level Test 1 $50 242 Fourth Level Test 2 $50 243 Fourth Level Test 3 $50 250 PSG/I1 see note 1 $75 $500+ 251 FEI Prix St. Georges $60 252 FEI Intermediare I $60 253 FEI Intermediare A/B TOC $60 254 FEI Intermediare II $60 255 FEI Grand Prix $60 256 Developing Horse TOC $60 261 FEI Jr Rider Ind Test $75 262 FEI YR Individual Test $75 263 FEI Pony Individual Test $75 264 FEI Children Team Test $75 265 FEI Yg Rider GP16-25 Test $60 271 USDF Freestyle # * $75 272 FEI Freestyle TOC *

Open BLM, Open GAIG/USDF-Q, Open Amateur Sweepstakes Open, BLM, GAIG/USDF-Q Open, BLM, GAIG/USDF-Q Open Open, BLM, GAIG/USDF-Q Open, BLM, GAIG/USDF-Q

NAJYRC /USEF-Q NAJYRC/USEF-Q USEF-Q USEF-Q

Open, BLM, GAIG/USDF-Q Open, BLM, GAIG/USDF-Q $75

280 USEF Tr 3, 1st 3, 2nd 3, 3rd 3, 4th 3 GAIG/USDF-Q $50 281 FEI ParaEquestrian TOC $60 290 USEF Five-Year_Old Prel Test FEI WBC Q $75 291 FEI Six-Year-Old Prel Test FEI WBC Q $75 292 FEI Seven-Year-Old Prel Test FEI WBC Q $75 293 USEF Young Horse Four Year Old $60 SUNDAY 301 Training Level Test 1 Open $50 302 Training Level Test 2 BLM, Open $50 303 Training Level Test 3 Open, GAIG/USDF-Q $50 311 First Level Test 1 Open $50 312 First Level Test 2 BLM, Open $50 313 First Level Test 3 Open, GAIG/USDF-Q $50 321 Second Level Test 1 Open $50 322 Second Level Test 2 BLM, Open $50 323 Second Level Test 3 Open, GAIG/USDF-Q $50 331 Third Level Test 1 Open $50 332 Third Level Test 2 BLM, Open $50 333 Third Level Test 3 Open, GAIG/USDF-Q $50 341 Fourth Level Test 1 Open $50 342 Fourth Level Test 2 BLM, Open $50 343 Fourth Level Test 3 Open, GAIG/USDF-Q $50 351 FEI Prix St. Georges Open, BLM, GAIG/USDF-Q $60 352 FEI Intermediare I Open, BLM, GAIG/USDF-Q $60 353 FEI Intermediare A/B TOC Open $60 354 FEI Intermediare II Open, BLM, GAIG/USDF-Q $60 355 FEI Grand Prix Open, BLM, GAIG/USDF-Q $60 356 USEF Developing Horse PSG USEF-Q $75 357 USEF Developing Horse GP USEF-Q $75 363 FEI Pony Freestyle USEF-Q $75 364 FEI Children Individual Test USEF-Q $75 365 FEI Yg Rider GP 16-25 Test Brentina Cup Qualifier $75 371 USDF Freestyle # * Open, BLM, GAIG/USDF-Q $75

SUNDAY (cont) 372 FEI Freestyle TOC * Open, BLM, GAIG/USDF-Q $75 373 FEI Jr Rider Freestyle NAJYRC /USEF-Q $75 374 FEI Yg Rider Freestyle NAJYRC /USEF-Q $75 375 FEI ParaEquestrian MFS TOC $75380 USEF Tr 3, 1st 3, 2nd 3, 3rd 3, 4th 3 GAIG/USDF-Q $50 381 FEI ParaEquestrian TOC $55 390 USEF Five-Year_Old Final Test Markel/USEF Q & FEI WBC Q $75 391 FEI Six-Year-Old Final Test Markel/USEF Q & FEI WBC Q $75 392 FEI Seven-Year-Old Final Test FEI WBC Q $75 393 USEF 4 Year Old test Markel/USEF Q $75 400 Dressage Equitation AA, JR/YR $35

USEF-Q = Qualifying for the USEF National Championships GAIG/USDF-Q = Great American/USDF Regional Dressage Championship qualifying class. NAJYRC /USEF– Official Qualifier for the 2018 Adequan FEI North American Junior Young Rider Championships & the 2018 AGCO/USEF Junior and Young Rider National Championships Markel/USEF Q Qualifier for the 2018 Markel/USEF Young Horse Championship FEI WBC Q: Qualifying for the 2018 World Breeding Championships BLM =Colonel Bengt Ljungquist Memorial Championship qualifying class. JR/YR—Juniors & Young Riders - list birthdate on entry. AA = Amateur - enclose copy of USEF Amateur card with entry.

Classes will be split AA (Adult Amateur) , J (JR/YR), O (Open) if entries warrant. Freestyle TOC = Test of Choice. State Level on entry. # Freestyles - please state level on entry form.. Training level is not a qualifier. Music for Freestyles must be on CDs provided by competitor to announcer at least two hours before scheduled ride.

LEVELS Training - Grand Prix. All tests will be current editions. NCDCTA Recognized. AQHA approved

Awards - Prize in classes of 3 or more and six ribbons. Separate awards/ribbons for O, AA, JR/YR in any dressage class with 4 or more in any division. Exception: Open, GAIG/USDF qualifying & CLBM scored & pinned together. Results are submitted electronically to each organization and scores are tabulated by each rider’s designated status (O, AA, JR/YR) regardless of how the classes are pinned by the show. Special High Score ribbons (Ex. Equitation, Freestyle, Opportunity, Intro & YH tests) sponsored by:

Thoroughbred High Score Award; Sponsored by the Jockey Club. Eligible horse must provide T.I.P. numbers to the show secretary. For more information, visit www.tjctip.com. All classes countexcept Equitation, Freestyle, & YH tests.`

Hanoverian High Score Award: Sponsored by the American Hanoverian Society. To the highest scoring Hanoverian at any level. No AHS membership required. Please bring papers or include with entry.

North American Danish Warmblood Association to the highest scoring NADWA member-owned registered horse. Please bring or include with entry horse registration papers & NADWA membership

National Dressage Pony Cup High Score: awarded to the pony receiving the highest percent-age score in the show. No NDPC memberships required.

AMATEUR SWEEPSTAKES CLASSES Prize money $500 plus 1/3 of entry fees of horses who have competed in class: 1st: 30%, 2nd: 18%, 3rd: 16%, 4th: 14%, 5th: 12%, 6th: 10%. Classes 200, 210, 220, 230 & 240 are limited to Amateurs only. To enter these classes riders must enclose a copy of a USEF Amateur card with their entry. Horse/Rider combinations can not have shown at a level above the sweepstakes level entered at this show. NOTES 1 to be eligible for prize money horse/rider combination must not have competed higher than the level of this class

PRO/AM TEAM CHALLENGE Teams of 3-4 1 Pro, 2 to 3 amateurs/juniors/young riders. Teams sign up with secretary at beginning of show. Each team rider must have at least 2 scores . Team placings by overall average of all scores submitted for each team.

Guest horses are welcome but must send in a completed entry form with user fee plus the $30 office fee, submit a current coggins, and pay either stabling or day parking.

FREESTYLES Music for freestyles must be on CDs provided by the competitor to announcer at least two hours prior to the start of the freestyle class. Music in MP3 format should be emailed to robertbelton@nc.rr.com at least 1 week prior to the show Management requests that all entries be created on EqEntries.com. If you do not already have a user account with EqEntries.com, please sign up! You can print and mail your entry with a personal check, or pay online with a credit card. If you chose to pay online there is a 5% fee. There is no charge to join EqEntries, create an entry, or print an entry. So, if you chose to pay by personal check, the service is free. We appreciate your using the preferred entry method. Online entries at www.equestrianentries.com/ Questions regarding Equestrian Entries, their services, or help can be attained by emailing: Helpme@equestrianentries.com STABLING 300 permanent stalls ranging from 10 x 10 to 12 x 12 with doors center-aisled barns. Initial bedding only. Please order extra bedding in advance $8 per bag ARENAS Four 20m x 60m on screenings and two 20m x 60m sand competition arenas. Sand and grass warm-up are-as. No one on foot is permitted in the warm-up arenas—all coaching must be done from the side. ENTRIES EACH ENTRY MUST HAVE COPIES OF ALL REQUIRED DOCUMENTATION ATTACHED. Include legible e-mail address on entry. All definitions and rules relating to this show are covered under the General Guidelines in the front pages of this book. Full refund if scratch is received by closing date less office fee. No refunds after closing date or after start of competition. This includes classes cancelled due to severe weather or other emergency conditions. All entries received after the closing date will incur a $20 late fee if accepted. Entries are limited on a first come - first served basis. Management reserves the right to add, combine or divide classes, add/substitute judges, or make any changes required by circumstances. Every class offered herein which is covered by the rules and specifications of the current USEF rule book will be conducted and judged in accordance therewith. Post entries will be placed on a waiting list to fill scratches. All “No Shows” that have not contacted the show office prior to first ride will be considered a scratch for the rest of the show and time slots may be filled. Horses entering the grounds must be accompanied by documentation of Equine Influenza Virus and Equine Herpes Virus (Rhinopneumonitis) vaccinations within six months prior to entering the stables. Horses not in compliance with this rule may be required to leave the competition grounds upon request by Competition Management. Check show website for changes in this policy which may go into effect at a later date by USEF. Attention Competitors: Each competitor is responsible for supplying the show management with the correct and required association numbers of USDF and/or USEF for the horse, owner, rider, coaches, and trainer, before the day(s) of the competition. The scores of competitors who fail to supply correct numbers may not count towards national awards. The proof of these numbers must be in the form of either their ac-tual membership/ registration cards or a facsimile of them. Members that are unable to produce the mem-berships cards/registrations or a facsimile will be asked to sign an affidavit and pay an affidavit fee. All entries are taken on a first come, first served basis. Late entries received after the show has filled will be put on a wait list on a as-received basis. Send in the entries as soon as possible to assure entry to the show. Only one horse/rider combination per entry form per show. TIMES Official times available Thursday at the secretary's stand. Confirmations will be e-mailed upon receipt of entry. Riders assume responsibility for verifying correct entry information. Management not responsible for errors. Times and stabling will be posted on our website one week prior to the show. www.carolinadressage.com  

FEES Make check payable to Viewpoint Enterprises and mail with entry, negative coggins and copies of necessary membership cards to Secretary. Post entries will be placed on a waiting list to fill scratches. Bounced check policy: Void entry and incur a $35 charge. Entries placed on a waiting list until a money order, certified check or cash is received. Credit cards incur a 2.5% fee If ponies are entered in FEI Pony Test(s) and in need of a USEF measurement card, an appointment for measuring MUST be made with show management prior to the show. The official measurement session will be scheduled Thursday, May 10, 2018. Owners of ponies needing measurement will be charged a fee not to exceed $100 to cover the fee charged by the official veterinarian required for the measurement

.DIRECTIONS Pinehurst Harness Track, 200 Beulah Hill Road, Pinehurst, NC 28374. Located on N.C. 5 in Pinehurst, N.C. From North: US 1 or US 15/501, exit at Morganton Road in Southern Pines, turn west (right) toward Pinehurst. Follow Morganton to end, turn South (left) on NC 5. Use main Harness Track entrance on left. From the West, take US 220 (I 73/74 corridor) to NC 211 east towards Pinehurst. Turn right at NC 5, Harness Track is 1.7 miles on left. From South: US 1 to Aberdeen, turn left (West) on NC 5 to Harness Track, approx. 6 miles on right. Alternate route from US #1 North or South: turn at 15/501 North in Aberdeen and turn left at Morganton Road traffic light (Pinecrest Plaza shopping center). Proceed until Morganton Rd ends and turn left on NC 5. Harness Track entrance is on the left. NAJYRC/Pony Rider/Bren na Cup/Children/PSG & GP Developing Horse Programs/World Breeding Championships (WBC) Contact the USEF at www.usef.org or phone 859-225-6918 for information and guidelines Golf Cart Rental: Carolina Carr iage 910-295-0574 ACCOMMODATIONS : Comfor t Inn, 9801 US Hwy 15/501, Pinehurst, NC 28374 910-215-5500. Special rate. Please mention horse show. Complimentary hot breakfast, pool, fitness center, guest laundry & business center, wireless internet, adjacent to 2 restaurants and coffee shop. HOSPITALITY Food available on the grounds during the day. Friday evening cocktail party for competitors, sponsors, vendors and guests. Each horse entry receives one free ticket to party. Extra tickets may be ordered at $20 per ticket. Catered luncheon Sat. and Sun. for Sponsors next to main arena. Contact show management for sponsorship information. CAMPING Limited independent camping is available for $40 per night—water & electric only OTHER All dogs must be leashed and attached to a person or immovable object. VENDOR’S ROW Fair Barn will be filled with an eclectic mix of vendor’s. Come prepared to shop! 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 Com-

For Class Fees see individual class list GAIG/USDF Qualifying add $15 USEF Show Pass (non-member) $45 USEF fee per horse $23 (D & M: $15, USEF: $8 USDF non-member $35 Stall weekend (including Tacks) $135 2 bags bedding included Extra nights $30 Turnout Paddock weekend $50

Day Parking $35 per day per horse not stabled on grounds RV hookup/per night $40 water & electric Late fee (if accepted) $20 Add/change fee/per class $10 exempt changes due to scheduling conflict Office fee $30 Guest Horses $35 Extra Bedding ordered in advance $8/bag Extra Party Tickets $20

petitions 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 $45 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 lim-ited 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 Na-tional Federation, 10) USEA beginner novice division; and 11) assistant handlers in Dressage Sport Horse Breeding classes. Rules and Regulati EVERY CLASS OFFERED HEREIN WHICH IS COVERED BY THE RULES AND SPECIFICATIONS OF THE CURRENT USEF RULE BOOK WILL BE CONDUCTED AND JUDGED IN ACCORDANCE THEREWITH. All questions not covered in these rules and regulations shall be decided by the show management whose decision shall be final. Every horse entered for competition will comply with the rules of the horse show management, but manage- ment will, in no case, be responsible for any loss or damage that may occur, and it shall be Condition of entry that each exhibitor shall hold this horse show and the officials and employees of the show blameless for any loss or accident to his horse, employees, equipment, which may occur from sickness, fire or otherwise. The management reserves the right to refuse, accept conditionally, or to cancel any entries, disqualify any riders or exhibitors, prohibit entries and cancel award prizes without claims for damages; to cancel or combin to exhibitors; to change rings or rotate judges. Exhibitors are notified that any act of discourtesy or disobedience to the judges or officials, on the part of the owner, manager, rider, or groom shall disqualify the horse, and the owner shall forfeit his entry fee and other fees. Show management reserves to itself the power to prohibit any person from attending or showing a horse in the ring and to remove any groom or horse from the show without being liable for compensation.

In accordance with the 1989 Federal Waste Tracking Act, which restricts the disposal of medical waste, bio -hazardous medical waste containers will be provided in the stable area. All exhibitors and their agents are responsible for the proper disposal of this waste. No person will be allowed in the show ring during the time of judging except the exhibitor and those having official or requested duties to perform.

Coaches are not allowed within the warm-up arena and must remain outside the arena at all times.

It is the tradition of the show that riders be correctly attired for the class in question, that attendants be presented. Management may in its discretion bar any person from entering the ring if not suitably presented to appear before an audience. 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 filed 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.

Show Management reserves the right to vary or add officials and refuse any entry for a cause; to disqualify any exhibitor and/or his or her horse for cause; to cause an exhibitor to forfeit his or her ribbons and winnings for cause; to return any entry and/or stall fee before or during the show for cause; all without being liable for damage or compensation. Show management reserves the right to make any changes deemed necessary for the safe and efficient conduct of this competition. Neither the Organizing Committee, show volunteers and staff, the facility or its owners, any host GMO, USEF or USDF or their members will be responsible for any damage, injury, or loss to persons, horses, or property of exhibitors or spectators. All owners and competitors are personally responsible for damages to third parties caused by themselves, their employees, their agents or their horses. They are therefore strongly advised to take out third-party insurance providing full coverage for partici-pation in equestrian events at home and abroad, and to keep the policy up to date. Important notice to all affected parties: Third parties may come upon the property or enter the facilities where any herein described or listed event will occur; provided, that this is a license to enter the premises, for the purpose of observing or participating in the event, but not otherwise, and such license to any individual is subject to revocation by the owner, lessee or organizer, and entry for any purpose other than granted herein, shall be deemed criminal trespass and subject to appropriate legal proceedings. No exhibitor may withdraw horses from a licensed show after it has commenced, or remove them from the show grounds without permission of the show secretary (GR 805). Tired of horse show cuisine? Become a show sponsor and join us under the tent overlooking the arenas for a catered gourmet luncheon Sat & Sun. Contact Kay Whitlock at kaydq@fastmail.fm for sponsorship packages. ENTRY DOCUMENTATION REQUIREMENTS Include with entry documentation copies of: · ♦ Current USEF membership (or Show Pass fees) - Rider, Owner and Trainer (coach, if applicable) · ♦ Current USDF membership (or n/m #) - Rider and Owner. . Rider's USDF membership may be either Participating or GMO, Owner's USDF membership may be Participating, GMO or Busi-ness; if Rider/Owner's USDF # is a N/M ID #, the USDF nonmember fee must be paid ·♦ USDF Horse ID ·Current (1 Yr) negative coggins ·♦For Amateur classes - USEF membership card must declare Amateur ·♦ Juniors and Young Riders must include birthdate. · ♦ Freestyle entries must include documentation at the highest test of that level from a USEF recog-nized show. For Great American/USDF Qualifying Classes also include: · ♦ State "Qualifying" and include $15 per Qualifying class ·♦ Copies of USEF and USDF Horse Registrations (not HID #s) - document must list owner ·♦ Rider must have current Participating membership and Owner must have current Participating or Business membership in USDF ·Rider and Owner must be current members of USEF Opportunity Classes Requirements No memberships or horse registrations are required however classes will be conducted under USEF rules. All entries must have 3 signatures - Rider, Owner and Trainer. Legal Guardian must sign for riders under 18 yrs. Trainer blank must be signed by person over 18 who assumes responsibility for horse. (Parents who sign as trainer are exempt from membership require-ments). If a coach is listed on the entry form they, must sign the signature space on the back. Questions? contact the show secretary. See www.usdf.org and www.usef.org and/or USEF Rule Book for further details on entry requirements. Contact the USEF Dressage Dept. at (859) 258-2472 and the USDF at 829-971-2277.

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Official Use Only BRIDLE #

COMPETITION NAME COMPETITION DATES

NAME OF HORSE PREVIOUS NAME (IF ANY) USEF# USDF# FOR SALE

BREED SEX HEIGHT COLOR COGGINS DATE (ENCLOSED COPY) SIRE DAM

DAM’S SIRE COUNTRY OF BIRTH YEAR OF BIRTH BREEDER FEI/PASSPORT # GROOM

CLASS NO. DIVISION CLASS DESCRIPTION QUAL Y/N FEES

SUBTOTAL CLASS FEES AND QUALIFYING FEES

USEF Show Pass FEES $ PER NON-MEMBER

USDF NON MEMBER FEE $ 5 PER NON-MEMBER

OFFICE FEE AND/OR BRIDLE # FEE

USEF HORSE FEES

$8 USEF FEE + $ DRUG FEE = $ .00

STABLING FEES STALL @ $ /STALL

TACK STALLS STALL @ $ /STALL

BEDDING BALES @ $ /BALE

NON COMPETING HORSE FEE

SPONSORSHIP

GROUNDS FEE OR OTHER FEES

OTHER

LATE/CHANGE/BANK CHARGES FOR CC

TOTAL FEES

RIDER/HANDLER

USEF# USDF# FEI/LOCAL#

ADDRESS

CITY/ST/ZIP

CELL PHONE JR/YOUNG RIDER BIRTHDAY

EMAIL ADDRESS

RIDER CITIZENSHIP (IF NOT USA )

RIDER STATUS (CIRCLE ONE): JR/YG AA OPEN

OWNER

USEF# USDF# LOCAL#

ADDRESS

CITY/ST/ZIP

CELL PHONE

EMAIL ADDRESS

OWNER CITIZENSHIP (IF NOT USA )

TRAINER

USEF# USDF# LOCAL#

ADDRESS

CITY/ST/ZIP

CELL PHONE

EMAIL ADDRESS

COACH

USEF# USDF# LOCAL#

ADDRESS

CITY/ST/ZIP

Please Fill Out Both Sides of This Form. Reverse side MUST be SIGNED.

Stabling Information & Special Requests: Please list only ONE name (either individual or barn) for entire group (so we can get everyone together)

Group/Self Tue Wed Thu Fri Sat Sun Mon

Stalls

Tack Stalls Stable Group: Contact:

I hereby agree to release, indemnify and hold harmless USDF, its instructors, officers, directors, agents, and volunteers from and against any and all loss, liability or damage arising from or because of, or in connection with, participation in this competition or related activities. I also hereby agree to release, indemnify and hold harmless the competition liscensee, show management, competition staff, show committee and members, officers, directors, agents, and volunteers from and against any and all loss, liability or damage arising from or because of, or in connection with, participation in this competition or related activities.

Federation Entry Agreement Effective By entering a Federation-licensed Competition and signing this entry blank as the Owner, Lessee, Trainer, Manager, Agent, Coach, Driver, Rider,

Handler, Vaulter or Longeur and on behalf of myself and my principals, representatives, employees and agents, I agree that I am subject to the Bylaws and Rules of The United States Equestrian Federation, Inc. (the “Federation”) and the local rules of the Competition. I agree to be bound by the Bylaws and Rules of the Federation and of the competition. I will accept as final the decision of the Hearing Committee on any question arising under the Rules, and agree to release and hold harmless the Competition, the Federation, their officials, directors and employees for any action taken under the Rules. I represent that I am eligible to enter and/or participate under the Rules, and every horse I am entering is eligible as entered. I also agree that as a condition of and in consideration of acceptance of entry, the Federation and/or the Competition may use or assign photographs, videos, audios, cable-casts, broadcasts, internet, film, new media or other likenesses of me and my horse taken during the course of the Competition for the promotion, coverage or benefit of the Competition, sport, or the Federation. Those likenesses shall not be used to advertise a product and they may not be used in such a way as to jeopardize amateur status. I hereby expressly and irrevocably waive and release any rights in connection with such use, including any claim to compensation, invasion of privacy, right of publicity, or to misappropriation. The construction and application of Federation rules are governed by the laws of the State of New York, and any action instituted against the Federation must be filed in New York State. See GR908.4.

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 AGREE that “the Federation” and “Competition” as used herein includes the Licensee and Competition Management, as well as all of their

officials, officers, directors, employees, agents, personnel, volunteers and Federation affiliates. I AGREE that I choose to participate 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 the Competition involve inherent dangerous risks of accident, loss, and serious bodily injury including broken bones, head injuries, trauma, pain, suffering, or death. (“Harm”).

I AGREE to hold harmless and release the Federation and the Competition from all claims for money damages or otherwise for any Harm to me or my horse and for any Harm of any nature caused by me or my horse to others, even if the Harm arises or results resulted, directly or indirectly, from the negligence of the Federation or the Competition.

I AGREE to expressly assume all risks of Harm to me or my horse, including Harm resulting from the negligence of the Federation or the Competition.

I AGREE to indemnify (that is, to pay any losses, damages, or costs incurred by) the Federation and the Competition and to hold them harmless with respect to claims for Harm to me or my horse, and for claims made by others for any Harm caused by me or my horse while at the Competition. I have read the Federation Rules about protective equipment, including GR801 and if applicable, EV114, and I understand that I am entitled to wear protective equipment without penalty, and I acknowledge that the Federation strongly encourages me to do so while WARNING that no protective equipment can guard against all injuries. If I am a parent or guardian of a junior exhibitor, I consent to the child’s participation and AGREE to all of the above provisions and AGREE to assume all of the obligations of this Release on the child’s behalf. I represent that I have the requisite training, coaching and abilities to safely compete in this competition.

I AGREE that if I am injured at this competition, the medical personnel treating my injuries may provide information on my injury and treatment to the Federation on the official USEF accident/injury report form.

BY SIGNING BELOW, I AGREE to be bound by all applicable Federation Rules and all terms and provisions of this entry blank and all terms and provisions of this Prize List. If I am signing and submitting this Agreement electronically, I acknowledge that my electronic signature shall have the same validity, force and effect as if I affixed my signature by my own hand. Copied from USEF website

OWNER’S/AGENT’S SIGNATURE

(MANDATORY) RIDER/HANDLER SIGNATURE

(MANDATORY) TRAINER’S SIGNATURE

(MANDATORY) COACH’S SIGNATURE

(IF APPLICABLE)

PRINT NAME PRINT NAME PRINT NAME PRINT NAME

PARENT/GUARDIAN SIGNATURE IF RIDER/DRIVER/TRAINER/HANDLER/VAULTER/LONGEUR IS UNDER 18 PRINT PARENT/GUARDIAN NAME

RIDER EMERGENCY CONTACT INFORMATION

NAME OF CONTACT/RELATIONSHIP: PHONE:

FILL OUT ONLY IF THE COMPETITION YOU ENTER ON THIS ENTRY FORM OFFERS CERTAIN USE OF CHARGE CARDS!! (Check in the prize list or individual competition requirements)

VISA AMEX CARD NO. - - - EXP DATE MasterCard Other NAME ON CARD: CVV #

BILLING ADDRESS ZIP CODE

USEF Competition Name: USEF#:Competition Division(s) and Rating(s):

WAYS TO SAVE AS A US EQUESTRIAN MEMBER

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