USEF/USDF # M 5, 2018

Transcription

1 USEF/USDF # M 5, 2018 L 2 C D E M 17-18, 2018 S C H, A, SC P L Manager/Entry Secretary Kay Whitlock Cell: PO Box 478; Southern Pines, NC kaydq@fastmail.fm Competition Management: Viewpoint Enterprises, Inc Kay Whitlock, President Show website: Online Entries: Judges Joan Darnell (S) Jodi Lees (S) Technical Delegate: Pat Maykuth Veterinarian on call: Aiken Equine Farrier On Call: Michael Grant EMT:Wade Hardin Class List All classes listed below are USEF/USDF/NCDCTA recognized. To enter these classes rider/owner/trainer must all be members of USEF or pay a non-member fee for each. Rider & owner must be USDF Participating or group members or pay a non-member fee. All horses must have at least a USDF HID # to enter. In regards to the Great American Insurance Group/USDF Regional Championship qualifying classes, horses must be USDF lifetime registered and USEF annual or lifetime recorded, owners and riders are required to have an active USEF membership, owners must have a USDF Participating or Business Membership, riders must have a USDF Participating Membership BLM= qualifying class for Col Lundquist Championships Saturday 101 Training - 1 OPEN 102 Training - 2 OPEN & BLM 103 Training 3 OPEN & First First - 2 BLM 113 First - 3 OPEN & Second Second - 2 BLM 123 Second - 3 OPEN & Third Third - 2 BLM 133 Third - 3 OPEN & Fourth Fourth - 2 BLM 143 Fourth - 3 OPEN & FEI Prix St George- BLM, OPEN & FEI Intermediare I- BLM, OPEN & FEI Intermediare A/B TOC - O 154 FEI Intermediare II- BLM, OPEN & FEI Grand Prix - BLM, OPEN & 2018 GAIG/ USDF Q 156 USEF & FEI Yg Horse TOC O 157 ParaEquestrian TOC 171 USDF Freestyle TOC- BLM, OPEN & FEI Freestyle TOC - BLM, OPEN & USEF Tr 3, 1st 3, 2nd 3, 3rd 3, 4th 3 TOC 2018 Sunday 201 Training 1 OPEN 202 Training - 2 OPEN & BLM, 203 Training - 3 OPEN & First - 1 OPEN 212 First - 2 OPEN & BLM 213 First - 3 OPEN & Second - 1 OPEN 222 Second - 2 OPEN & BLM 223 Second - 3 OPEN & Third - 1 OPEN 232 Third - 2 OPEN & BLM 233 Third - 3 OPEN & Fourth - 1 OPEN 242 Fourth - 2 OPEN & BLM 243 Fourth - 3 OPEN & FEI Prix St George- BLM,OPEN & FEI Intermediare I- BLM,OPEN & 2018 GAIG/ USDF Q 253 FEI Intermediare A/B TOC - O 254 FEI Intermediare II- BLMBLM,OPEN & FEI Grand Prix - BLM,OPEN & 2018 GAIG/ USDF Q 56 USEF & FEI Yg Horse TOC O 257 ParaEquestrian TOC 271 USDF Freestyle TOC- BLM,OPEN & FEI Freestyle TOC - BLM,OPEN & USEF Tr 3, 1st 3, 2nd 3, 3rd 3, 4th 3TOC Dressage Seat Equitation AA,JR/YR Continued

2 Class List USDF Introductory Tests These tests are designed for beginner horses and riders. No memberships or registrations are required for rider/owner/trainer/horse and non-member fees are not charged, however the USEF $23 is required Saturday 10 USDF Intro - A 11 USDF Intro - B 12 USDF Intro - C Sunday 20 USDF Intro - A 21 USDF Intro - B 22 USDF Intro - C Class List USEF Opportunity Tests These tests are designed to introduce dressage to non-members. No memberships or registrations are required for rider/owner/trainer/horse and non-member fees are not charged. The USEF $23 fee is also not charged. Riders/horses may cross enter Opportunity classes with Open classes, however, the USEF fee of $23 is charged. Saturday 5101 Training 1 Opportunity 5102 Training 2 Opportunity 5111 First 1 Opportunity 5112 First 2 Opportunity Sunday 5202 Training 2 Opportunity 5203 Training 3 Opportunity 5212 First 2 Opportunity 5213 First 3 Opportunity FEES Make check payable to Viewpoint Enterprises and mail with entry, negative coggins and copies of necessary membership cards to Secretary. Bounced check policy: Void entry and incur a $30 charge. Entries placed on a waiting list until a money order, certified check or cash is received. Credit cards will incur a 3% fee. Intro/Training/Fourth/ $50 Opportunity/PE/YH $50 DSE $35 FEI, $60 Freestyle $75 Great American/USDF Qualifying add $15 USEF non-member Show Pass $45 USEF fee per horse $23 (D & M: $15.00 USEF: $8) USDF non-member $35 Stall weekend (including Tacks) $120 2 bags bedding included Extra nights $30 Extra Bedding ordered in advance $8/bag Guest Horses $35 Day Parking $35 per day per horse not stabled on grounds RV hookup/per night $40 water & electric Late fee (if accepted) $20 Office fee $30 STABLING: 152 Permanent 12x12 stalls with full doors in center aisle barns. Two bags of shavings are given with each stall including tack stalls.. Additional temporary stabling available. ACCOMMODATIONS : Clarion Inn, 155 Colony Parkway, Aiken 29803; Special Horse Show rate (Group special rate cutoff date 21 days prior.) DIRECTIONS: Highfields, 198 Gaston Rd, Aiken, SC Located less than 1 mile from downtown Aiken. From I-20 take Exit #22 US 1 and follow towards Aiken for approx. 7 miles. At the 2nd light (Sunoco on left and just pass the Bi-Lo on right) turn left onto Hwy 118. Merge right at first light onto Beaufort Street. Follow Beaufort Street almost to the 2nd light and take a left onto Barnwell (State Credit Union on left, street sign only on right). Cross over a dirt road and you will see the Highfield sign and gates. From Richland Ave. in Aiken: Heading East on Richland go past Williamsburg to the next stop light. Take a left onto Beaufort St at the Dollar General. Take the first right (before the Credit Union) onto Barnwell. Highfields is straight ahead. ARENAS: 5 All-weather 20m x 60m competition rings, large all-weather fenced warm-up arenas. Additional warmup on grass polo field.

3 = Great American/USDF Regional Dressage Championship qualifying class. 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 - Intro through Grand Prix. All tests will be current editions. 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 with entry. For more information, visit All classes count except 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 AQHA Approved Show National Dressage Pony Cup High Score: awarded to the pony receiving the highest percentage score in the score. No NDPC memberships required. Entries - Entries are limited on a first come-first serve basis. Each entry MUST complete the enclosed entry form including all required numbers and signatures. Management reserves the right to add, combine or divide classes, add or substitute judges or make any changes required by circumstance. Management requests all entries be created on If you chose to pay online, there is a 5% fee If you do not already have an account, please sign up, it is free. You can print and mail your entry with a personal check for no charge. Credit Cards incur a 3% fee. Questions regarding EqEntries, their services, or help can be obtained by ing HelpMe@EqEntries.com Guest Horses - Guest horses are welcome. Requires completed entry, coggins, vaccine certificate, guest horse fee, office fee and stabling or day parking fee. Post Entries - All entries received after the cut off date, will incur a $20.00 late fee if accepted. Entries can be put on a wait list to fill scratches. All No Shows which have not contacted the show office prior to ride will be considered a scratch for the rest of the show and time slots maybe filled. Full refund if scratch is received by closing date less office fee. No refunds after closing date or after start of completion. This includes classes canceled due to severe weather or other emergency conditions. Health Requirements - All horses must have a copy of a current negative coggins.. At Federation licensed competitions, 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. Rules and Regulations 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 management 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.

4 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 combine unfilled classes, or to reschedule classes after due notice 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 neatly dressed and the horses properly presented. Management may in its discretion bar any person from entering the ring if not suitable presented to appear before an audience. USEF Membership Statement (GR901.9) 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 $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 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. 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. 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. Please provide the USEF/USDF Master Verification ( or photocopies of membership & registrations cards. All entries are taken on a first come, first served basis. Late entries are placed on a wait list on an as-received basis. Please take pity on the show secretary and send in the entries as soon as possible to allow management to add judges and rings as needed. Refunds less the $30 office fee will be refunded prior to the closing date. Only one horse/rider combination per entry form per show.

5 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 participation in equestrian events at home and abroad, and to keep the policy up to date. Dogs must be leashed and attached to a person or immovable object. Dog owners failing to comply will be issued a yellow warning card and non-compliance may result in further USEF penalties. Numbers must be worn at all times when a horse is not in a stall. Haul-in horses must have bridle number on at all times including time when tied to a trailer. Headgear Rule for Dressage From the time horses are officially admitted to the competition grounds by competition management, anyone mounted on a horse at any time on the competition grounds, including non-competing riders, riders on non-competition horses, and those competition in all classes and tests must wear protective headgear as defined by this rule and otherwise in compliance with USEF rule GR801. Any rider violating this rule at any time must immediately be prohibited from further riding until such headgear is properly in place. Protective headgear is defined as a riding helmet which meets or exceeds ASTM (American Society for Testing and Materials)/SEI (Safety Equipment Institute) standards for equestrian use and carries a SEI tag. The harness must be secured and properly fitted. Riders may substitute horses once they have entered upon presentation of a Vet Certificate for the incapacitated horse, or a bill-of-sale, and only in classes in which the first horse was entered. The Secretary must be notified at least 24 hours before the class/classes take place and a new entry form must be completed. Hazardous Weather/Accident/Acts of God, and Emergency Policy: Management reserves the right to cancel any classes due to hazardous weather, Acts of God, accident, or emergency. Every effort will be made to reschedule with priority given to any Championship or qualifying classes being offered. No refunds for cancellations due to hazardous weather, Acts of God, accidents, or emergencies. 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).

6 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 Business; if Rider/Owner's USDF # is a N/M ID #, the USDF nonmember fee must be paid USDF Horse ID or USEF/USDF horse registration Current (1 Yr) negative coggins and vaccine certificate (6 month) 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 recognized 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 requirements). If a coach is listed on the entry form they, must sign the signature space on the back. Questions? contact the show secretary. See and and/or USEF Rule Book for further details on entry requirements. Contact the USEF Dressage Dept. at (859) and the USDF at

7 USEF Competition Name: Competition Division(s) and Rating(s): USEF#: WAYS TO SAVE AS A US EQUESTRIAN MEMBER Save 5% on qualifying purchases at checkout Protect yourself with discounted liability and AD&D insurance Buy 10 bags of feed and get one free! Save up to 28% on equipment like Gators (TM) and lawnmowers Get started with a discounted emergency roadside assistance plan. PLUS MANY MORE!

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9 2018 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 RIDER/HANDLER CLASS NO. DIVISION CLASS DESCRIPTION QUAL Y/N FEES USEF# USDF# FEI/LOCAL# ADDRESS CITY/ST/ZIP CELL PHONE JR/YOUNG RIDER BIRTHDAY ADDRESS RIDER CITIZENSHIP (IF NOT USA ) RIDER STATUS (CIRCLE ONE): JR/YG AA OPEN OWNER USEF# USDF# LOCAL# ADDRESS CITY/ST/ZIP CELL PHONE ADDRESS OWNER CITIZENSHIP (IF NOT USA ) TRAINER USEF# USDF# LOCAL# ADDRESS CITY/ST/ZIP CELL PHONE ADDRESS COACH USEF# USDF# LOCAL# ADDRESS CITY/ST/ZIP Please Fill Out Both Sides of This Form. Reverse side MUST be SIGNED. SUBTOTAL CLASS FEES AND QUALIFYING FEES USEF Show Pass FEES $45 PER NON-MEMBER USDF NON MEMBER FEE $35 PER NON-MEMBER OFFICE FEE AND/OR BRIDLE # FEE USEF HORSE FEES $8 USEF FEE + $15 DRUG FEE = $23.00 CDI HORSE FEES $8 USEF FEE + $ 20 DRUG FEE = $28.00 IHP DISCIPLINE FEE ($35 IF REQUIRED) STABLING FEES $ /STALL TACK STALLS $ /STALL BEDDING $ /BALE NON COMPETING HORSE FEE SPONSORSHIP GROUNDS FEE OR OTHER FEES OTHER LATE/CHANGE/BANK CHARGES FOR CC TOTAL FEES 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:

10 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 GR 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 9/25/2017 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

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