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Opening Date: June 18, 2016 Closing Date: July 5, 2016 Dressage at Red Tail Farm I 1100 Rattlesnake Bridge Road Bedminster, NJ 07921 USEF/USDF #333303 – Level 2 July 19, 2016 2016 Great American Insurance Group/USDF Qualifying Event 2016 Col. Bengt Ljunquist Memorial Championship (BLM) Qualifying Event 2016 ESDCTA Recognized Manager: Amy Gimbel 908.310.5541 (cell) [email protected] Secretary: Amy Gimbel 908.310.5541 (cell) [email protected] Judges: Barbara Ebner, NJ (S) Marlene Schneider, MN (S) TBD Show Office Phone: 908.439.3345 Online Entries: https://www.equestrianentries.com Technical Delegate: Dorothy Maxfield, NJ (r ) Volunteer Coordinator: Amy Gimbel 908.310.5541 (cell) [email protected] Farrier: Tom LaRose 907.399.3477 Dave Vanderhoof 201.787.1363 EMT: Will be on grounds, contact through the show office Licensee: Linda C. Dietz Veterinarian: B.W. Furlong & Associates 908. 439. 2821 – on call

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Page 1: Dressage at Red Tail Farm I - static1.squarespace.com – Qualifying classes for the 2016 BLM Championship (cblm.org). Riders must be members of a participating organization at the

Opening Date: June 18, 2016 Closing Date: July 5, 2016

Dressage at Red Tail Farm I

1100 Rattlesnake Bridge Road Bedminster, NJ 07921

USEF/USDF #333303 – Level 2 July 19, 2016

2016 Great American Insurance Group/USDF Qualifying Event

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

2016 ESDCTA Recognized

Manager: Amy Gimbel 908.310.5541 (cell) [email protected]

Secretary: Amy Gimbel 908.310.5541 (cell) [email protected]

Judges: Barbara Ebner, NJ (S) Marlene Schneider, MN (S) TBD

Show Office Phone: 908.439.3345

Online Entries: https://www.equestrianentries.com

Technical Delegate: Dorothy Maxfield, NJ (r )

Volunteer Coordinator: Amy Gimbel 908.310.5541 (cell) [email protected]

Farrier: Tom LaRose 907.399.3477 Dave Vanderhoof 201.787.1363

EMT: Will be on grounds, contact through the show office

Licensee: Linda C. Dietz Veterinarian: B.W. Furlong & Associates 908. 439. 2821 – on call

Page 2: Dressage at Red Tail Farm I - static1.squarespace.com – Qualifying classes for the 2016 BLM Championship (cblm.org). Riders must be members of a participating organization at the

Opening Date: June 18, 2016 Closing Date: July 5, 2016

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, USDF 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 processed on first come basis.

Class # Fee Level Test Qualifications1 $35 USDF Introductory TOC

101 $35 Training Level Test 1 Open 102 $35 Training Level Test 2 Open/CBLM Q103 $35 Training Level Test 3 Open/USDF GAIG Q104 $35 Training Level Test 1 Opportunity 111 $45 First Level Test 1 Open 112 $45 First Level Test 2 Open/CBLM Q113 $45 First Level Test 3 Open/USDF GAIG Q114 $45 First Level Test 1 Opportunity 121 $45 Second Level Test 1 Open 122 $45 Second Level Test 2 Open/CBLM Q123 $45 Second Level Test 3 Open/USDF GAIG Q124 $45 Second Level Test 3 Dover Medal AA USDF GAIG Q131 $45 Third Level Test 1 Open 132 $45 Third Level Test 2 Open/CBLM Q133 $45 Third Level Test 3 Open/USDF GAIG Q141 $45 Fourth Level Test 1 Open 142 $45 Fourth Level Test 2 Open/CBLM Q143 $45 Fourth Level Test 3 Open/USDF GAIG Q150 $55 FEI PSG Open/USDF GAIG Q/CBLM Q151 $55 FEI Intermediare I Open/USDF GAIG Q/CBLM Q152 $55 FEI Intermediare II Open/USDF GAIG Q/CBLM Q153 $55 FEI Grand Prix Open/USDF GAIG Q/CBLM Q154 $55 FEI TOC Open/USDF GAIG Q/CBLM Q160 $55 USDF MFS TOC Open/USDF GAIG Q/CBLM Q161 $60 FEI MFS TOC Open/USDF GAIG Q/CBLM Q170 $45 FEI YH TOC Open171 $35 Dressage Seat Equitation

Page 3: Dressage at Red Tail Farm I - static1.squarespace.com – Qualifying classes for the 2016 BLM Championship (cblm.org). Riders must be members of a participating organization at the

Opening Date: June 18, 2016 Closing Date: July 5, 2016

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 USDF 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.

CBLM – 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

Page 4: Dressage at Red Tail Farm I - static1.squarespace.com – Qualifying classes for the 2016 BLM Championship (cblm.org). Riders must be members of a participating organization at the

Opening Date: June 18, 2016 Closing Date: July 5, 2016

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 DR120.1-6 Protective Headgear must be worn at all times when mounted (exception for FEI competitors exempt by FEI 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 Farrier will be on call.

Page 5: Dressage at Red Tail Farm I - static1.squarespace.com – Qualifying classes for the 2016 BLM Championship (cblm.org). Riders must be members of a participating organization at the

Opening Date: June 18, 2016 Closing Date: July 5, 2016

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 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.

Page 6: Dressage at Red Tail Farm I - static1.squarespace.com – Qualifying classes for the 2016 BLM Championship (cblm.org). Riders must be members of a participating organization at the

Opening Date: June 18, 2016 Closing Date: July 5, 2016

Page 7: Dressage at Red Tail Farm I - static1.squarespace.com – Qualifying classes for the 2016 BLM Championship (cblm.org). Riders must be members of a participating organization at the

Opening Date: June 18, 2016 Closing Date: July 5, 2016

Page 8: Dressage at Red Tail Farm I - static1.squarespace.com – Qualifying classes for the 2016 BLM Championship (cblm.org). Riders must be members of a participating organization at the

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

Page 9: Dressage at Red Tail Farm I - static1.squarespace.com – Qualifying classes for the 2016 BLM Championship (cblm.org). Riders must be members of a participating organization at the

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

Page 10: Dressage at Red Tail Farm I - static1.squarespace.com – Qualifying classes for the 2016 BLM Championship (cblm.org). Riders must be members of a participating organization at the

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):

Page 11: Dressage at Red Tail Farm I - static1.squarespace.com – Qualifying classes for the 2016 BLM Championship (cblm.org). Riders must be members of a participating organization at the

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:

Page 12: Dressage at Red Tail Farm I - static1.squarespace.com – Qualifying classes for the 2016 BLM Championship (cblm.org). Riders must be members of a participating organization at the

USEF Competition NameCompetition Division(s) and Ratinqs:

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•.‘ A

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scoi S°’

5oro’S ?o

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WcA’