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Entry NYUC Show Jumping Rally Team Entry Form rabies

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					              NY/UC Show Jumping Rally Team Entry Form
                           Opening Date: April 26, 2010 Closing Date: May 25, 2010
   Club:
           Name                                    Rating      Horse                           Division*   NI (Y/N)
Rider 1
Rider 2
Rider 3
Rider 4
HM
   * - Available Divisions are QD, Q1, Q2, Q3, N1, and N2 (see Info Packet)

   Chaperone
   Chaperone’s address, email and phone:
   Coach’s name, email and phone:
   These Pony Clubbers are in good standing with the USPC, Inc., and the Pony Club, with all dues
   and insurance paid as of this date. The horse entered is the regular mount of the rider, regularly
   ridden at local rallies, and to my knowledge, qualified to ride at the level entered.
   District Commissioner ______________________________________ Date ___________
   Or Joint District Commissioner _______________________________ Date ___________
   Rider’s Fees: $100                                                              Total Rider’s Fees: __________
   Stable Manager’s Fee: $50                                                    Stable Manager’s Fee: __________
   Incomplete Entry Fee **: $10.00 per Item (Rider and HM)                     Total Incomplete Fees: __________
                                                                              TOTAL ENCLOSED: $ ___________
   # of trailers _________
   Special requests (sharing trailer with another team)
   ___________________________________________________________________________________
   CHECK LIST:
   ___ 2010 Team Entry Form (one per team or partial team)
   ___ Original 2010 Show Jumping Competitor Activity/Rally Release Form (one per competitor)
   ___ current Negative Coggins (one per horse)
   ___ current Rabies Certificate (one per horse)
   ___ Veterinarian Drug Certificate (only if horse needs medication)
   ___ Signed Chaperone Duty Form (one per team/chaperone)
   ___ Signed Coaches Form (one per coach)
   ___ Volunteer Form
   ___ Club Check for Team/Partial Team Entry Fees Payable to NY/UC
   ___ All Required Paperwork for Championships sent to Robbie Kost (See Info Packet)
   ** - Entries are considered incomplete if any of the required paperwork is not enclosed with team
   entry OR if all information is not entered.

                   Mail Entries to: Martha Ruff                 8 Springvale Rd Croton, NY 10520

				
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