Prize schedule and entry form PRE Entry closing date Monday 9 th January 2017

Werribee Park National Equestrian Centre 170 K Road, Werribee South 3030 Victoria 21 st 22 nd January 2017 Breeds on Show :- Clydesdale Shire Percheron Fjord Highland Pony Friesian Gypsy Cob Drum Horse Haflinger Reg Partbred Heavy Horses Classes to see/do :- Led Breeds Harness Business Turnouts Show Driver Heavy Harness Horses Ridden Heavy Horses Heavy Horse Dressage Junior handler/rider/driver Fancy Dress Long Reining Log Snig Obstacle Course Ringside Entertainment:- Show n Shine Static Display - Horse Drawn Carts - Farm Implements Working Horse Displays Breed Information Ringside Seating Merchandise/Trade Village Food & Refreshments Exhibitor Dinner Auction Ringside Commentary Prize schedule and entry form PRE Entry closing date Monday 9 th January 2017 Grand Champion Led Heavy Horse of the Show Gordon Phillips Perpetual Trophy S E Jorgensen Novice Clydesdale Exhibitor Supreme Champion Tradesman Turnout Robert Wood Memorial Trophy Supreme Champion Harness Exhibit Ron King Perpetual Trophy 2017 Australian Long Reining Champion ~ 500 in prizemoney Public Entry: 10 per person /U16 Free For all enquiries, please contact :- Robert Ronzio ph 0408 534 881 E: robertronzio@bigpond.com Val Perkins ph 0438 599 590 E: 1 dave.perkins6@bigpond.com www.nchhf.wordpress.com

RULES AND CONDITIONS All persons competing in the 2017 National Clydesdale & Heavy Horse Festival (NCHHF) do so on the condition that they are bound by the rules and conditions contained in the schedule and entry form. Liability All competitors are to sign an indemnity form prior to competing All competitors acknowledge and agree as a condition of participating that neither the National Clydesdale and Heavy Horse Festival, members, competitors, participants, officials, volunteers, medical personnel, and persons, promoters, sponsors, advertisers, owners and lessees of premises used to conduct the Commonwealth Clydesdale Horse Society Victoria Branch, shall be under and liability for my death bodily injury, loss or damage which may be sustained or incurred by me, as a result of my participation in or present at the event, except in regard to any rights I may have arising under the Trade Practices Act 1974. Competitors acknowledge that equestrian activities are dangerous and that accidents causing death, bodily injury, disability and property damage, can and do happen. Competitors accept this responsibility on behalf of their horse handlers, employees and servants. Rules of Entry Safety The appointed stewards and nominated officials shall have the right to: Bar or remove any horse not in good condition or be clean, or a competitor from any class or event where a breach of safety is perceived. Order the removal from the show grounds of any entry or competitor if any horse considered by the judge or ringmaster to be labouring excessively under a load, incapable of work or a potential danger shall be removed upon request. Competitors will ensure that: No other animal or livestock other than horses are permitted in the ring. All sled and log events are to be at a walk unless otherwise specified. ONLY HEAVY HORSES CAN COMPETE Single horses can enter twice in any one event with different competitors. Proof of registration to be produced if the CCHS Victoria Branch requests. All instructions from stewards and nominated officials are obeyed at all times. Officials have the power to disqualify or remove competitors if instructions are not obeyed. Any competitor removed from competition may also have prize or appearance money withheld. All harness vehicles and equipment used at the NCHHF are in sound and safe condition. All horses at the NCHHF are kept under proper control at all times. All horses in ridden and driven sections must be bitted (no bitless bridles accepted). All horses being driven in harness or in long reins must wear winkers. Covered footwear must be worn at all times in marshalling and competition areas and all competitors must be appropriately dressed for the event entered. Helmets to be worn in ridden classes and must comply to Australian Standards AS/NZS 3838. Junior handlers/riders/drivers under 12 years of age must wear a helmet that complies to Australian Standards AS/NZ 3838. Any shouting, whipping or swearing will incur disqualification. No alcohol is to be consumed in the competition or marshalling areas. All vehicles used in competition at the NCHHF are to be of the type traditionally used by heavy horses, except where event guide states otherwise. Judges and stewards decision is final. Only accredited persons allowed in the competition rings. No horses are allowed in the ring areas prior to the program starting on each day. 2

RING 1a SATURDAY 9am start- Judge: Nicky Enrich (QLD) CLYDESDALE 1. Best Presented Clydesdale 2. Led Clydesdale Gelding 6 years & over 3. Led Clydesdale Gelding 3 years & over 4. Led Clydesdale Gelding under 3 years Champion & Reserve Champion Led Clydesdale Gelding Trophy Sponsored by the de Hann family in memory of Diane de Hann CLYDESDALES Mares 5. Led Clydesdale Mare 4 years & over 6. Led Clydesdale Filly 3 years Champion & Reserve Champion Led Clydesdale Mare CLYDESDALES Fillies 7. Led Clydesdale Filly 2 years 8. Led Clydesdale Filly Yearling & under Junior Champion & Reserve Champion Led Clydesdale Filly Sponsored by the Weavers Family in memory of Dave Weavers SHIRES 9. Best Presented Shire 10. Led Shire Gelding Champion & Reserve Champion Led Shire Gelding 11. Led Shire Mare 3 years and over 12. Led Shire Filly 2 years and under Champion & Reserve Champion Led Shire Mare or Filly 13. Led Shire Stallion 3 years and over 14. Led Shire Colt 2 years and under Champion & Reserve Champion Led Shire Stallion or Colt Supreme Led Shire (sponsored by Shire Horse Breeders Assoc) CLYDESDALES Stallions 15. Led Clydesdale Stallion 4 years & over 16. Led Clydesdale Stallion 3 years Champion & Reserve Champion Clydesdale Stallion CLYDESDALE Colts 17. Led Clydesdale Colt 2 years 18. Led Clydesdale Colt Yearling & under Junior Champion & Reserve Champion Led Clydesdale Colt Supreme Led Clydesdale ~ Phyllis Mahncke Memorial BEST JUNIOR CLYDESDALE EXHIBIT 2 YEARS & Under (Filly, Colt, Gelding) Hugh Barrie Special Award donated by Haylands Clydesdale Stud S E JORGENSEN NOVICE CLYDESDALE EXHIBITOR Awarded for the Best Clydesdale owned by an Exhibitor who has not previously won a first prize in a led Clydesdale class at the NCHHF. TROPHY SUPPORTED BY BOX VALLEY CLYDESDALES Stan Jorgensen conducted the 'Box Valley Stud' at Dimboola and later Murtoa. He produced big successful teams for the Royal Melbourne Show and imported 'Roughlands Telstar' Scotland. BEST FOAL AWARD Open to all purebred registered heavy horse breeds GRAND CHAMPION LED HEAVY HORSE Gordon Phillips Perpetual Trophy Donated by Aarunga Clydesdales * All Supreme led winners from ring 1 eligible for Grand Champion Led * JUNIOR HANDLERS ANY BREED 19. Junior Handler under 12 (accompanied by an adult) 20. Junior Handler 12 17 years Sponsored by - Jika Farm Clydesdales (A & Y Clarke) RING 1b- SATURDAY 9am start- Judge: Maureen Pengally (VIC) *All horses to be registered with their relevant breed society* PERCHERON 21. Best Presented Percheron 22. Led Percheron Gelding 23. Led Percheron Stallion or Colt Champion & Reserve Champion Led Male Percheron 24. Led Percheron Mare or Filly Champion & Reserve Champion Led Female Percheron Supreme Led Percheron (sponsored by Australian Percheron Society) FRIESIAN 25. Best Presented Friesian 26. Led Friesian Gelding 27. Led Friesian Stallion or Colt Champion & Reserve Champion Led Male Friesian 28. Led Friesian Mare or Filly Champion & Reserve Champion Led Female Friesian Supreme Led Friesian GYPSY COB (ring sponsored by Australian Gypsy Horse Assoc) 29. Best Presented Gypsy Cob 30. Led Gypsy Cob Gelding 31. Led Gypsy Cob Stallion or Colt Champion & Reserve Champion Led Male Gypsy Cob 32. Led Gypsy Cob Mare or Filly Champion & Reserve Champion Led Female Gypsy Cob Supreme Led Gypsy Cob DRUM HORSE (ring sponsored by Australian Gypsy Horse Assoc) 33. Best Presented Drum Horse 34. Led Drum Horse Gelding 35. Led Drum Horse Stallion or Colt Champion & Reserve Champion Led Male Drum Horse 36. Led Drum Horse Mare or Filly Champion & Reserve Champion Led Female Drum Horse Supreme Led Drum Horse HIGHLAND PONIES (ring sponsored by Highland Pony Australia) 37. Best Presented Highland Pony 38. Led Highland Pony Gelding 39. Led Highland Pony Stallion or Colt Champion & Reserve Champion Led Male Highland Pony 40. Led Highland Pony Mare or Filly Champion & Reserve Champion Female Led Highland Pony Supreme Led Highland Pony FJORD ( ring sponsored by Fjord Promotional Group Australia) 41. Best Presented Fjord 42. Led Fjord Gelding 43. Led Fjord Stallion or Colt Champion & Reserve Champion Led Male Fjord 44. Led Fjord Mare or Filly Champion & Reserve Champion Led Female Fjord Supreme Led Fjord HAFLINGER (ring sponsored by Karen Noonan) 45. Best Presented Haflinger 46. Led Haflinger Gelding 47. Led Haflinger Stallion or Colt Champion & Reserve Champion Led Male Haflinger 48. Led Haflinger Mare or Filly Champion & Reserve Champion Female Led Haflinger Supreme Led Haflinger PART BRED HEAVY HORSES *Must be registered Partbred with a recognised heavy breed or register* 49. Best Presented Part Bred Heavy Horse 50. Led Part Bred Heavy Horse Gelding 51. Led Part Bred Heavy Horse Mare or Filly 52. Led Part Bred Heavy Horse Stallion or Colt Champion & Reserve Champion Led Part Bred Heavy Horse 53. Fancy Dress Heavy Horse (possibly during lunchtime) 3

RING 1 - SATURDAY 1.30pm approx start Judge: Kevin Collins (VIC) RING 2 SATURDAY 9am start-judge: Graeme Mahncke (VIC) HARNESS - TURNOUT Ring split into: 2 a) long reining, 2b) log snig course, 2 c) obstacle course Horses in this ring must show characteristics of heavy horse breeding. SINGLE & MULTIPLE TRADESMAN TURNOUT Open to two or four wheel vehicle showing characteristics of a Tradesman and Delivery vehicle, depicting the profession or purpose for which the vehicle is being shown. Sulkies/jinkers/show carts and other light harness vehicles are not permitted in Tradesman Turnout classes. Exhibits entered in Tradesman & Delivery Turnout will be judged on 100 points according to the following scale:- Horse -40, Vehicle -30, Harness- 10, Goods carried/displayed -10, General Appearance -10 = 100 points SHOW CART TURNOUT Open to two wheel show carts, heavy sulkies and heavy jinkers suitable for heavy horses. Exhibits entered in the Show Cart Turnout will be judged on 100 points according to the following points scale :- Horse -50, Vehicle -30, Harness -10, General Appearance -10 =100 points SINGLE TRADESMAN TURNOUT 54. Miscellaneous Tradesman Turnout 4 wheel single horse 55. Miscellaneous Tradesman Turnout 2 wheel single horse 56. Baker/Milkman/Butcher 2 or 4 wheel Turnout 57. Long Shaft Brake Turnout Champion & Reserve Champion Single Horse Tradesman Turnout MULTIPLE TRADESMAN TURNOUT 58. 2 or 4 wheel Tradesman Turnout pair of horses 59. 2 or 4 wheel Tradesman Turnout 3 or more horses Champion & Reserve Champion Multiple Horse Tradesman Turnout SUPREME CHAMPION TRADESMAN TURNOUT Perpetual Trophy In Memory of Robert Wood SHOW CART OR LIGHT VEHICLE TURNOUT 60. Heavy Turnout Show Cart 61. Medium Turnout Show Cart Champion & Reserve Champion Show Cart Turnout HARNESS DRIVING COMPETITION- simple cone course Judge: Nicky Enrich (QLD) *** Any vehicle can be used in the harness driving competition 62. Gentleman Driver in any vehicle 63. Lady Driver in any vehicle (trophy from Ben Koi Clydesdale Stud) 64. Novice Driver in any vehicle 65. Junior Driver (under 17yrs) in any vehicle can be assisted We thank the following breed societies for your sponsorship:- WORKING DRAFT Long Reining Horse MUST wear winkers with collar & hames or winkers & roller -no bitless bridles permitted. Logs/sled /tyre, chains and backband will be supplied by organisers and judged at the walk only. RING 2a LONG REINING through cones & ground poles 66. Novice or beginner (in long reins, single horse) can be assisted 67. Gentleman Driver (in long reins, single horse) 68. Lady Driver (in long reins, single horse) 69. Junior Driver under 17yrs (in long reins, single horse) can be assisted 70. Tyre driven cone course Novice Driver Single Horse 71. Sled or log driven cone course Open Driver Single Horse 72. Sled driven cone course Pairs NOVELTIES 73. Novelty Sled Vegetable Snatch 74. 2 person Sled Competition (single horse) RING 2b to follow on from ring 2a LOG SNIG separate course set (VWDHA course/ rules) 75. Log Snig Single Horse ** 76. Log Snig Pair of Horses ** Class 75 is a qualifying class for the Australian Long Reining Championship on the Sunday. Points awarded go towards final score. All Long Reining through cones classes, Log Snigging classes Points awarded for:- 1 st Place 3 points 2 nd Place 2 points 3 rd Place 1 point Points accumulated go towards Champion Exhibitor of Ring 2 RING 3- SATURDAY approx 1.30pm start Judges: Kath Pearce (purebred) Maureen Pengally (partbred) HEAVY HORSES UNDER SADDLE (Open to all pure and part bred registered heavy horses) 77. Purebred Heavy Horse under saddle 16hh and over 78. Purebred Heavy Horse under saddle under 16hh 79. Ridden Part Bred Heavy Horse over 15hh 80. Ridden Part Bred Heavy Horse under 15hh 81. Ridden Pleasure Heavy Horse - ridden in a snaffle bit & no spurs or whip 82. Ridden Heavy Horse suitable for combined training (inc jumping) Champion & Reserve Champion Ridden Heavy Horse Champion prize/trophy sponsored by Louise and Tony Scott and family All Class Pre Entries 5 All Classes entered on the day 10 Dressage Pre Entry Only 20 Show n Shine FREE 4

RING 1 SUNDAY 9am start Judge: Nicky Enrich (QLD) MEDIUM /HEAVY DELIVERY HORSES DELIVERY HORSE CLASSES Horses in this section must show characteristics of heavy horse breeding. Defined vehicles for this class as a miscellaneous two or four wheel vehicle must show characteristics of a Tradesman and Delivery vehicle, depicting the profession or purpose for which the vehicle is being shown. Vehicles not defined as a Tradesman and Delivery vehicle are only permitted in the Delivery Horse in Show Cart class. SINGLE DELIVERY HORSE IN TRADE VEHICLE 83. Delivery Horse in a 2 wheel vehicle - single horse 84. Delivery Horse in a 4 wheel vehicle - single horse Champion & Reserve Champion Medium/Heavy Delivery Horse PAIR AND MULTIPLE DELIVERY HORSES IN TRADE VEHICLE 85. Delivery Pair of Horses in a miscellaneous trade vehicle 86. Multiple Horses (3 or more) in a miscellaneous trade vehicle Champion & Reserve Champion Delivery Horse Team DELIVERY HORSE IN SHOW CART 87. Medium Delivery Horse 88. Heavy Delivery Horse Champion & Reserve Champion Delivery Horse SUPREME CHAMPION HARNESS EXHIBIT Ron King Perpetual Trophy 89. Novice Delivery Horse in any vehicle RING 2 Sunday 9am start Judge: Graeme Mahncke (VIC) Ring split into: 2 a) long reining, 2b) log snig course, 2 c) obstacle course Long Reining Horse MUST wear winkers with collar & hames or winkers and roller no bitless bridles permitted. Sled, chains and backband will be supplied by organisers RING 2a NOVELTIES 90. Novelty Sled Vegetable Snatch 91. 2 person Sled Competition (single horse) RING 2c AUSTRALIAN LONG REINING CHAMPIONSIPS 92. Long rein through obstacle course single horse 93. Long rein through obstacle course with sled single horse Course set with 10 interesting obstacles, exhibitor with the most amount of points is declared our 2017 Australian Long Reining Champion - Points awarded from the Log Snig go towards the final scores - You must complete both above classes 92 & 93 - One run only per class - Time allowed 5 minutes to complete course. - Judged at the walk only Each of the 10 obstacle has 10 points = 100 points perfect score - 5 penalty points deducted for each of the following: - refusal, horse touching obstacle, driver error, horse disobeying, jibbing or outside assistance required. - 2 penalty points deducted for each 10 seconds over time - 3 refusals at one obstacle = instant disqualification Champion Exhibitor of Ring 2 Judged on overall highest points & wins Saturday & Sunday RING 3 SUNDAY 9am start Judge: Kath Pearce (QLD) HEAVY HORSE Rider Classes 94. Best Presented Rider/Horse combination 95. Rider under 12 years of age 96. Rider 12-17 years of age 97. Rider over 17 years to 21 years of age 98. Rider over 21 years of age Champion & Reserve Champion Rider 99. Novice Rider (not won a first place previously at any show) 100. Ridden Heavy Horse ~ Handy Mount UNOFFICAL HEAVY HORSE DRESSAGE - Judge: Kath Pearce STRICTLY PRE ENTRY BY CLOSING DATE 9 th January 2017 Prizes for winners and ribbons for individual tests. Highest score over both tests Sash & Prize Open to purebred registered and partbred registered heavy horses. Unregistered heavy horses are eligible however must be of genuine draught type (ie feathering, heavy build and over 16hh). Horses to compete in a maximum of two tests to be ridden over the one level EA Tests Preparatory Test C Preparatory Test D Preliminary 1.1 Preliminary 1.3 Novice 2.1 Novice 2.3 SHOW AND SHINE all weekend (FREE TO ENTER ) Static display of working draught and heavy horse drawn vehicles for those people that have no horse and want to show off their implement or carts. Vehicles will be contained in a fenced area in the Trade Villlage. Farm Implements - Unrestored farm implement - Restored farm implement Business Turnouts - Unrestored business turnout - Restored business turnout Times will be emailed to dressage exhibitors 2 days prior and also posted on our facebook and website page www.nchhf.wordpress.com A separate area will be fenced off for farm implement to be used as a working display during the Festival. We sincerely thank Kathryn Potempski from Dreamscope Photography who will be our official event photographer for the weekend. A designated area will be set up adjacent the Trade Village for exhibitors to use and for Kathryn to take official photos of all Championship/Supreme winners. 2017 AUSTRALIAN LONG REINING CHAMPION 500 in Prizemoney 5

2016 National Clydesdale & Heavy Horse Festival Thank you to our Sponsors & Supporters We sincerely thank our exhibitors, our sponsors, our judges, the heavy horse supporters for your continued support and of course the volunteers who work tirelessly over the Festival weekend. We would like to thank the following for their generous sponsorship and/or product donations for our hugely successful 2016 National Clydesdale & Heavy Horse Festival. de Haan Family Darren Phelan Weavers Family Pare Forge Haylands Clydesdale Stud Bunyip Saddlery Aarunga Clydesdales Helen Copeman Box Valley Clydesdales Granny Reilly Horse Feed Procom Services Fiona Dearing A & Y Clarke Wyndham Council Equitana Australia Tutt Bryant Definative Events Lyle Drayton Louise & Tony Scott Photo of Amy Scott with Louvale Sir Douglas and Scottish Judge Ronald Brewster 2016 National Clydesdale & Heavy Horse Festival 6

2017 National Clydesdale & Heavy Horse Festival Entry Form Pre Entry close Monday 9 th January 2017 ENTRIES ON DAY - DOUBLE THE FEE All horses entering in a horse breed section must be registered with that relevant breed society. Any exhibitor who is not a member of that horse breed society must pay the casual day insurance. All exhibitors to complete & sign a CCHS Waiver & Rules of Entry Acknowledgment with entry form. Class No or EA Tests Horses Name Handler/Driver/Rider Entry Fee Dressage 20 10 Enter on Day 5 Pre Enter For Dressage ( Pre Entry Only) please nominate your 2x tests Any exhibitor who is not a member of a heavy horse breed noted on the day must pay casual day insurance and complete the attached form. Stables @37 per night per horse bedding wood shavings only BYO or we can supply. Please indicate numbers of horses to be stabled:- Stallion x Gelding x Mare x Note: Stables must be cleaned out on exit or a 50 stable cleaning fee applies per stable. ALL FORMS MUST BE COMPLETED AND RETURNED WITH ENTRY (X Amount Required) X X X Total Entry Fees Casual Day Insurance (cover @20 adult/11 Under 17 years 37 Stable per night -per horse Nights required FRIDAY/SATURDAY/SUNDAY 78 Breeders Choice Shavings 85kg woolpack (a woolpack will last the weekend) X 5 Yard per night per horse X Powered Site per night @15 X Unpowered Site per night @10 X Saturday Night Dinner @ 10 p/p n/a WPNEC Horse Facility Fee PAID BY NCHHF TOTAL AMOUNT DUE NAME Address Mobile Email Post Code 7 Entry, signed forms & payment (cheque payble to Clydesdale Heavy Horse Festival) to be sent to:- Rob Ronzio, 29 Shaw Drive, Romsey VIC 3434 STRICTLY PRE ENTRIES TO BE RECIEVED BY MONDAY 9 th January 2017 unless notified.

Rules of Entry Acknowledgement All exhibitors must call at the secretary s office on entering the show to receive information and stabling allocations Where the number of applications for stables/yards exceeds the number available, allocations will be made at the discretion of the committee Wood shavings are the only bedding allowed at Werribee Park National Equestrian Centre in stables & yards Stables & yards are to be cleaned out by exhibitor on exit Stables not cleaned on exit the exhibitor will be charged a 50 cleaning fee per stable A light dinner and entertainment will be available on the Saturday night 10 per person - to be pre paid with entry White coats are to be worn when leading horses in led section - available for loan at the office. STALLIONS entered at the NCHHF are to wear green stallion identification discs and be handled/ridden/driven by persons over 18years old ALL exhibitors are required to sign and return the CCHS indemnity form with entry prior to entering grounds ALL exhibitors to be a current financial member of their respected breed society if not, CCHS casual day membership is payable upon entry to this event (which gives you cover for 12 months for CCHS run events) or present your current CCHS day membership card. Exhibitors are reminded that they should make themselves conversant with the regulations (as displayed on page 2 of the schedule) and sign the acknowledgement below. I hereby apply to enter the exhibits listed overleaf at my own risk and subject to the terms upon the conditions set out in the Society s regulations by which I agree to be bound, and I hereby certify the above particulars to be correct. This certificate of entry and the regulations shall constitute the whole agreement upon which entries are submitted and I agree that all representations and statements not appearing herein or in the regulations are hereby excluded. I hereby hold the society free from any liability in connection with any mistake or errors that may be made in these entries or in the catalogue of exhibits X X NAME NAME Date Date SIGNATURE OF EXHIBITOR(S) 8

CCHS EVENT INDEMNITY FORM PLEASE PRINT ALL DETAILS (one form per person) CCHS BRANCH: EVENT TITLE: VICTORIA 2017 NATIONAL CLYDESDALE & HEAVY HORSE FESTIVAL Name of Exhibitor in CCHS Event: Address: Contact Phone No: I agree and consent to being a participant in the above outlined event. I hereby also agree to release, discharge and to hold the Commonwealth Clydesdale Horse Society harmless for any accidents, harm and/or loss, which I may suffer as a result of participating in the outlined event. In addition, I hereby agree to indemnify the Commonwealth Clydesdale Horse Society and its servants, volunteers and agents for any loss, demands, damages, expenses, claims, actions and suits brought for and on behalf of myself and arising out of or in any way connected to the outlined event. I authorize the Commonwealth Clydesdale Horse Society to obtain any medical or hospital treatment as in its opinion may be required for myself. I agree that this indemnity shall extend to the decision of the Commonwealth Clydesdale Horse Society to obtain or administer such medical treatment and I further agree to pay the costs of such treatment. In the event of there being any know medical conditions for myself or the need for taking of medication which would affect the rendering of any urgent medical assistance, I give consent that my details be recorded below and kept in a confidential manner by the above named group organizing this event. Known Allergies: Medication: Signature: SIGNATURE OF EXHIBITOR Date: 9

The Commonwealth Clydesdale Horse Society Federal Council Inc. Reg. No. A0019631A ABN 24 748 123 650 P O Box 1053 Bendigo Victoria 3552 Telephone: (03) 5442 88 90 Facsimile: (03) 5442 5264 APPLICATION FOR CASUAL DAY PARTICIPANT INSURANCE (one form per person) NAME OF PARTICIPANT ADDRESS POSTCODE TELEPHONE EMAIL CCHS BRANCH: EVENT: VICTORIA 2017 NATIONAL CLYDESDALE & HEAVY HORSE FESTIVAL I wish to compete in an event conducted by this Society and/or a Branch of this Society and agree to pay the Casual Day Participant Insurance Levy. I understand that payment of this levy is required for insurance purpose and does not entitle me to membership of the Society, and that the annual Membership levy falls due on 1 st July of each year. I agree to abide by all decisions of the Society in relation to all matters arising out of or in connection with each event in which I participate. Enclosed please find remittance of 20.00 Adult (inc GST) being for Casual Day Participant Insurance. or 11.00 Junior (inc GST) I, as the participant accept the above agreement. Signature: Date: Printed Name: SIGNATURE & PRINTED NAME OF PARTICIPANT (signature & printed name of guardian if Junior under 17 years) 10