Official Prize List for the July at Lamplight I host to the National Dressage Cup and Small Championships July 20 & 21, 2018 and the July Dressage at Lamplight II host to the National Dressage Pony Cup Breed Show July 22, 2018

Featuring $25,000 Available NDPC Prize Money for and Small

Opening Date: Monday, June 4, 2018 Received By/Closing Date: Friday, July 6, 2018

Licensed by the United States Equestrian Federation USEF/USDF Recognized No. 316707 / 316701 Level Three Competitions Lamplight Equestrian Center, Wayne, IL

Official Qualifying Competition for: 2018 Markel/USEF Young and Developing Horse Dressage Championships 2018 Children Dressage National Championship 2018 USEF Pony Rider Dressage National Championship 2018 AGCO/USEF Junior and Young Rider Dressage National Championships 2018 USEF Young Adult ‘Brentina Cup’ Dressage National Championship presented by Dressage Today 2018 Great American/USDF Regional Championships

Judges: Natalie Lamping ‘S’, Charlotte Trentelman ‘S’, Carter Bass ‘S’, Anne Cizadlo ‘S’, Fatima Pawlenko-Kranz ‘R’ and Caryn Vesperman ‘r’

Technical Delegates (TDs): Janine Malone ‘R’ and Barbara Zukowski ‘r’

Veterinarian (on grounds): Mr. Marshall Steven 616-560-2518 Farrier (on grounds): Archie Linn 815-378-2766 EMT on grounds during show hours Licensee: Lamplight Equestrian Center, Wayne IL

Manager: William Solyntjes 612-991-6016 [email protected] Show Secretary and Entry Processing: Debbie Landon 507-208-6022 [email protected] Pony Cup contact: Jenny Carol 513-290-8070 [email protected]

Official prize list posted on www.dressageshowinfo.com

Page 1 General Information For All Competitors

Online entries: Available at www.dressageshowinfo.com or www.equestrianentries.com on opening date.

Mailed entries: Draw checks in US Funds only to Lamplight Equestrian Center - Check or Charge Card (Charge Card ran at show) Mail to: July Lamplight Dressage c/o Debbie Landon - Show Secretary, 4420 57th ST NW, Rochester, MN 55901

Reminder: This is two shows so you must submit TWO entry forms if entering both shows. Payment required with entry. The National Dressage Pony Cup and Small Horse Championships or NDPC show is in cooperation with the July Lamplight show I (Friday and Saturday) and the NDPC Breed show is in cooperation with the July Lamplight show II (Sunday). See page 6 for NDPC specific information.

Entry Fees: Office charge per entry: $45 per horse/rider combination per show Village of Wayne tax: $12.50 Tax per competing horse – payable once per weekend Late entries: $45 per show if entry RECIEVED after the Received by Date of July 6th Post entries at show: Will be taken as scheduling permits, class fee plus $10.00 Emailed entries: $10 per entry Charge card fee: $5 per entry Pony/Small Horse measurement: $35.00 per pony or small horse on Thursday, times will be scheduled $100 per pony or small horse for other times, arrangements must be made with show management NDPC Competitor dinner (Sat): $25 per ticket, $35 per ticket at show (limited number available), see page 9. Rider/Handler/Horse change: $25 for either rider, handler, or horse change after entries submitted Non-competing horses: $100 for the weekend. Must fill out entry form for bridle number and pay office fee. Stabling/Tack stall fees: Permanent and temporary stalls are 10’ x 10’ with doors. Weekend Stabling for both shows (12 PM Thursday to 7 PM Sunday): $170/stall – Barns A, B, Tent 1 $150/stall – Barns C, D, E, Tent 2 Show I Stabling (12 PM Thursday – 7 PM Saturday): $150/stall – Barns A, B, Tent 1 $130/stall – Barns C, D, E, Tent 2 Show II Stabling (12 PM Saturday – 7 PM Saturday): $75/stall – Barns A, B, Tent 1 $65/stall – Barns C, D, E, Tent 2 Daily Stabling (12 PM - 7 PM the following day): $75/stall – Barns A, B, Tent 1 $65/stall – Barns C, D, E, Tent 2 Additional nights stabling $35/stall – per night (other than show dates) Bedding, minimum of 2 bags $9/bag. Order on entry form or at show office. No initial bedding will be supplied. Or pay disposal fee $20/stall. Competitors not ordering 2 shavings will be charged a disposal fee per horse stall. RV Hookup: $50/night (includes water and electrical hookup) Golf cart rental: Players Golf Cart 815 874-8787. Competitors must contact Players Golf Cart directly for rental.

Entry Information Requirement: Competitors are responsible to include a copy of all required USDF and USEF memberships for horse, owner, rider, handler, trainer, and coach listed on entry form or pay non-member fees. Freestyle classes must include copy of qualifying test with entry.

USEF Equine Vaccination Rule & Health Requirements for Entry to Show Grounds in 2018: All horses entering the show grounds of a USEF licensed competition MUST be accompanied by documentation showing vaccinations for Equine Influenza Virus and Equine Herpes Virus (Rhinopneumonitis) within 6 months as well as have a current negative EIA/Coggins test (within 12 months) This is mandatory for every horse entry. See USEF rule GR845. Also, a health certificate (30-day) is needed on all out of state horses. Horses not entered in the show may not be brought onto the show grounds without prior arrangement with show management.

Address: Lamplight Equestrian Center, 6N940 Dunham Road, Wayne IL, 60184

Directions: From E, NE, and NW: I-90, exit Hwy 59. From Hwy 59: Stearns Road west. Turn south on Dunham Road and right onto Lamplight Trail (show entrance) From SE and SW: I-88, Exit Fairview N which turns into Dunham Road, Lamplight Trail on the left (show entrance).

Page 2 General Information For All Competitors

Entry Cancellation/Refunds: Cancellations accepted only in writing by mail or e-mail prior to or on the Received by Date. Entire entry refunded minus the office fee. No Refunds for any reason after the Received by Date. All fees collected on behalf of USEF/USDF to be submitted to the Federation provided all outstanding fees are paid in full; else it will be applied to those fees.

Great American Insurance Group (GAIG)/USDF Qualifying Classes: Indicate the class is to count for qualifying by placing a Q after the class number on your entry. Qualifying does not require a separate ride. An exhibitor riding in the Open, AA, or JR/YG rider classes must pay an additional $15 USDF qualifying fee to have this score entered in the GAIG/USDF qualifying division at that level.

Confirmation/Ride Times: Confirmation of entry will be e-mailed. All e-mail addresses must be clearly printed. Ride times and show updates will be posted on http://www.DressageShowInfo.com. Entries taken on a first come, first served basis. Entries may close early if time limits for judges are filled. Remaining entries received before the Received by Date will be placed on a wait list.

Awards for USEF Classes: Divisions (JR/YG, AA, Open) may be run concurrently as one class. Divisions will be pinned separately. Riders must clearly specify division choice. When no designation is made, riders will automatically be entered as open. Riders may enter only one division per class. Ribbons to sixth for each class. No awards for Qualifying classes. Championships and reserves awarded for the highest percentage at each USDF/USEF/FEI level at each division for show I only. Freestyles are excluded from all Championship and Reserve awards. For NDPC awards information, see the “National Dressage Pony Cup Information” on page 6.

Pony Riders/ Pony Measurements: See the “National Dressage Pony Cup Information” on page 6.

No Shows and Scratches: All “No Shows” that have not contacted the show office prior to their first ride will be considered a scratch for the rest of the show and time slots may be filled. Competitors enter with this understanding and agreement.

Accommodations: Lamplight’s official hotel, Courtyard by Marriott 630 377-6370, is located in St. Charles, Illinois which is approximately two miles from the show grounds. Other hotels in the St. Charles, Illinois area include: Hampton Inn 630 584-0222, County Inn & Suites 800-456-4000, Pheasant Run Resort 630 584-6300, and Hilton Garden Inn 630 584-0700.

Arenas: Outdoor arenas have all-weather GGT mix sand/fiber footing. Warm-up rings are of same footing. All tests in standard arena, unless entries warrant, then some tests may be held in a short arena.

Concessions: Food and concessions will be available on the show grounds during competition hours.

Warning: Under the Equine Activity Liability Act, each participant who participates in an equine activity expressly assumes the risks of engaging in and legal responsibility for injury, loss, or damage to person or property resulting from the risk of equine activities.

Weather/Acts of God/Accidents or Emergency Policy: Management reserves the right to cancel any classes due to hazardous weather, acts of God, accidents, or emergencies. Every effort will be made to reschedule with priority given to the USEF Program classes. No refunds for cancellations due to hazardous weather, acts of God, accidents, or emergencies. See USEF rule GR311.

Golf Carts/Mopeds/Other Motorized Vehicles: Must be at least 16 year of age, with valid driver's license to operate a golf cart, moped, or other motorized vehicles on show grounds. 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 lic ensed 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. The parent(s), legal guardian(s), or individual who signs the entr y blank as a parent or guardian of a minor operating a motorized vehicle in violation of this rule are solely responsible for any damages, claims, losses or actions resulting from that operation. Violations of this rule will be cause for sanctions against the pare nt(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 charge s being filed against any of the above individuals in accordance with Chapter 6. Wheelchairs and other mobility assistance devices for individuals with disabilities are exempt from this rule. See USEF rule GR 1301.7.

See the “General Regulations, Policies, and Entry Specifications” section later in this prize list for additional policies this show subscribes to and follows.

Page 3 July Dressage at Lamplight I and II Open Show Class List

Fri Sat Sun Class Name Divisions Class USDF Q # # # * indicates a GAIG/USDF Regional Qualifying class Offered Fee Fee 101 201 301 USDF Intro A JR-YR / AA / Open $40 102 202 302 USDF Intro B JR-YR / AA / Open $40 103 203 303 USDF Intro C JR-YR / AA / Open $40 104 204 304 USEF Training Level Test One JR-YR / AA / Open $40 105 205 305 USEF Training Level Test Two JR-YR / AA / Open $40 106 206 306 USEF Training Level Test Three * JR-YR / AA / Open $40 $55 107 207 307 USEF First Level Test One JR-YR / AA / Open $40 108 208 308 USEF First Level Test Two JR-YR / AA / Open $40 109 209 309 USEF First Level Test Three * JR-YR / AA / Open $40 $55 110 210 310 USEF Second Level Test One JR-YR / AA / Open $40 111 211 311 USEF Second Level Test Two JR-YR / AA / Open $40 112 212 312 USEF Second Level Test Three * JR-YR / AA / Open $40 $55 113 213 313 USEF Third Level Test One JR-YR / AA / Open $40 114 214 314 USEF Third Level Test Two JR-YR / AA / Open $40 115 215 315 USEF Third Level Test Three * JR-YR / AA / Open $40 $55 116 216 316 USEF Fourth Level Test One JR-YR / AA / Open $40 117 217 317 USEF Fourth Level Test Two JR-YR / AA / Open $40 118 218 318 USEF Fourth Level Test Three * JR-YR / AA / Open $40 $55 119 219 319 FEI Prix St George * JR-YR / AA / Open $50 $65 120 220 320 FEI Intermediare I * JR-YR / AA / Open $50 $65 121 221 321 FEI Intermediare II * JR-YR / AA / Open $50 $65 122 222 322 FEI Grand Prix * JR-YR / AA / Open $50 $65 USDF Freestyle * (specify test – USDF TR to 4th) 124 224 324 $50 $65 Training (TR) level is not eligible for qualifying. 125 225 325 FEI Freestyle * (specify test) $50 $65 FEI TOC * (specify test – no Freestyles, Young 126 226 326 JR-YR / AA / Open $50 $65 Horse or Para tests) USEF TOC * (specify test – no Freestyles or Young 127 227 327 JR-YR / AA / Open $40 $55 Horse tests) 128 228 328 Equitation – Dressage Seat $30 129 229 329 FEI Para TOC (any grade Team or Individual only) $40 130 230 330 FEI Para Freestyle TOC – state test $40 131 231 USEF 4 YR Old Horse Test (Practice) $50 132 232 FEI 5 Year Old Young Horse Final (Practice) $50 133 233 FEI 6 Year Old Young Horse Final (Practice) $50 134 234 FEI 5 Year Old Young Horse Preliminary (Practice) $50 135 235 FEI 6 Year Old Young Horse Preliminary (Practice) $50 136 236 USEF Developing PSG (Practice) $50 137 237 USEF Developing GP (Practice) $50 Materiale Classes 138 238 338 Three Year Old Fillies $40 139 239 339 Three Year Old Colts/Geldings $40 140 240 340 Four and Five Year Old Mares $40 141 241 341 Four/Five Year Old Stallions/Geldings $40

Page 4 July Dressage at Lamplight I and II Open Show Class List

Fri Sat Sun Class Name Divisions Class USDF Q # # # * indicates a GAIG/USDF Regional Qualifying class Offered Fee Fee Pony Classes (see Note below) 342 USDF Introductory A - Pony JR-YR / AA / Open $40 343 USDF Introductory B- Pony JR-YR / AA / Open $40 344 USDF Introductory C - Pony JR-YR / AA / Open $40 345 USEF Training Level Test One - Pony JR-YR / AA / Open $40 346 USEF Training Level Test Two - Pony JR-YR / AA / Open $40 347 USEF Training Level Test Three – Pony * JR-YR / AA / Open $40 $55 348 USEF First Level Test One - Pony JR-YR / AA / Open $40 349 USEF First Level Test Two - Pony JR-YR / AA / Open $40 350 USEF First Level Test Three – Pony * JR-YR / AA / Open $40 $55 351 USEF Second Level Test One - Pony JR-YR / AA / Open $40 352 USEF Second Level Test Two - Pony JR-YR / AA / Open $40 353 USEF Second Level Test Three – Pony * JR-YR / AA / Open $40 $55 354 USEF Third Level Test One - Pony JR-YR / AA / Open $40 355 USEF Third Level Test Two - Pony JR-YR / AA / Open $40 356 USEF Third Level Test Three – Pony * JR-YR / AA / Open $40 $55 357 USEF Fourth Level Test One – Pony JR-YR / AA / Open $40 358 USEF Fourth Level Test Two – Pony JR-YR / AA / Open $40 359 USEF Fourth Level Test Three – Pony * JR-YR / AA / Open $40 $55 FEI TOC – Pony * (specify test – no Freestyles, 360 JR-YR / AA / Open $50 $65 Young Horse or Para tests) USEF Qualifying Classes 361 USEF 4 YR Old Horse Test (Markel/USEF Qualifying) $65 362 FEI 5 Year Old Test Final (Markel/USEF Qualifying) $65 363 FEI 6 Year Old Test Final (Markel/USEF Qualifying) $65 157 FEI Pony Team (USEF Qualifying) $65 257 FEI Pony Individual (USEF Qualifying) $65 158 FEI JR Team (USEF Qualifying) * $65 $80 258 FEI JR Individual (USEF Qualifying) $65 159 FEI YR Team (USEF Qualifying) * $65 $80 259 FEI YR Individual (USEF Qualifying) $65 160 FEI Children Team (USEF Qualifying) $65 260 FEI Children Individual (USEF Qualifying) $65 364 USEF Developing PSG (USEF Qualifying) $65 365 USEF Developing GP (USEF Qualifying) $65 366 FEI GP 16 – 25 (USEF Qualifying) $65 Opportunity Classes 172 272 372 Training Level Test 1 Opportunity $40 173 273 373 Training Level Test 2 Opportunity $40

NOTE: Classes may not necessarily run in the order listed here.

NOTE: The Pony classes listed for the open show on Sunday are offered at each level as NDPC Partner Show classes and will not count toward the NDPC Awards at this show, however they will count towards NDPC Year-End Awards. Page 5 National Dressage Pony Cup and Small Horse Championships Information

Show Rules: . The National Dressage Pony Cup and Small Horse Championships (NDPC) is a two-day competition to be held during the July Lamplight I Dressage show on Friday and Saturday, July 20 and 21, 2018. . The two highest tests of each level are competed during the competition. . Ponies are 149cm or smaller and must have a USEF Pony Measurement card. Small horses, as designated by the NDPC, is any breed of horse or pony that measures taller than a pony, but less than 16hh with shoes. The official NDPC range is more than 149cm, to less than 163cm with shoes. . Each pony or small horse/rider combination must ride a designated test each day at the level they are competing to be eligible for prizes. See the NDPC class lists starting on page 10.

Level Friday, July 20 Saturday, July 21 Introductory Introductory Level Test B Introductory Level Test C Training Training Level Test 2 Training Level Test 3 First First Level Test 2 First Level Test 3 Second Second Level Test 2 Second Level Test 3 Third Third Level Test 2 Third Level Test 3 Fourth Fourth Level Test 2 Fourth Level Test 3 FEI ** FEI Test of Choice (TOC) ** FEI Test of Choice (TOC) ** FEI Pony Tests FEI Pony Team Test FEI Pony Individual Test ** The same FEI test (PSG, Intermediate I, Intermediate II, or Grand Prix) must be ridden each day.

. Ponies and small horses can compete in more than one consecutive level, but no more than two consecutive levels, even with more than one rider. . Ponies and small horses may not compete in more than three tests per day for National level tests or two tests per day for FEI level tests. . Eligible tests may be used as USDF qualifiers by paying the additional USDF $15 qualifying fee. . Readers are permitted for Introductory through Fourth level. . Whips are allowed per USEF rules.

Show Requirements: . All pony and small horse/rider combinations must be current members of the NDPC and have a USEF Pony Measurement or NDPC Small Horse Measurement forms completed and submitted before the start of the competition. . Ponies, small horses, riders, and owners must be current members of USDF (or pay a USDF non-member fee). Introductory riders are not required to be members. . Ponies, small horses, riders, owners, trainers, and coaches must be current members of USEF (or pay a USEF non- member fee). Introductory riders are not required to be members. . There are NO QUALIFYING SCORES necessary to enter.

Pony Measurements: . NDPC membership and proof of measurement must be submitted to the NDPC before the start of competition on July 20th The original measurement form or scanned copy of the original form can be submitted as proof of measurement. . Pony measurements will be available to competitors on Thursday, July 19th. Indicate on your entry that you need your pony measured at the show and a time will be schedule for you on Thursday. Measurement fee is $35. . Ponies over 3 years of age must have a current USEF Pony Measurement card. . Ponies 8 years and older will receive a USEF permanent measurement card. Ponies under 8 will receive a yearly/temporary USEF measurement card.

Page 6 National Dressage Pony Cup (NDPC) Information, continued…

Pony Measurements, continued… . Ponies without a current USEF Pony Measurement card must be measured before their first ride. . The show TD will provide pony competitors the USEF Pony measurement forms. DO NOT print them and bring them with you. . Ponies are to be presented in a halter with bridle number attached. Handler must be at least 18. . Ponies will be jogged in front of the show veterinarian. . Owners must be current members of USEF in order to receive a USEF Pony Measurement card. . All measurement rules and requirements are governed by USEF for pony measurements.

Small Horse Measurements: . NDPC membership and proof of measurement must be submitted to the NDPC before the start of competition on July 20th The original measurement form or scanned copy of the original form can be submitted as proof of measurement. . Small horse measurements will be available to competitors on Thursday, July 19th. Indicate on your entry that you need your horse measured and a time will be schedule for you on Thursday. Measurement fee is $35. . A small horse, as designated by the NDPC, is any breed of horse or pony that measures taller than a pony, but less than 16hh with shoes. The official NDPC range is more than 149cm, to less than 163cm with shoes. . Small horses over 3 years of age must have a current NDPC Small Horse Measurement form submitted to the NDPC prior to the start of competition on July 20th. . Small horses 8 years and older will be considered permanently measured. Small horses under 8 will have a temporary measurement status and must submit a new NDPC measurement form each year. . Small horses without a current NDPC Small Horse Measurement must be measured before their first ride. Small horses can be measured prior to coming to the show by a licensed, practicing veterinarian who is required to sign and verify the measurement on the NDPC Small Horse Measurement form. . NDPC measurement forms will be provided at the time of measurement to small horse competitors. . Small horses are to be presented in a halter with bridle number attached. Handler must be at least 18. . Small horses will not need to be jogged, only measured. . All measurement rules and requirements are governed by NDPC for small horse measurements. . Small horse measurements are not recognized by USEF and no USEF measurement card will be issued.

Musical Freestyles: . Only one Musical Freestyle test is required to qualify for prizes. . Musical Freestyle tests can be ridden on either Friday or Saturday, or can be ridden both days. . If a Musical Freestyle test is ridden more than once, the scores will be averaged. . Musical Freestyle Champion and Reserve will be calculated using a weighted scale per level. (see the Degree of Difficulty chart on the next page) . Champion and Reserve neck sashes for Open, AA, JR/YG (under 16) and JR/YG (17 - 21) will be awarded.

Pony Cup Awards: . If a pony or small horse/rider combination was Champion at Introductory through Fourth level at the NDPC Annual Show previously, the same pony or small horse/rider combination must compete at a higher level the following year to be eligible for awards. They may still compete at the same level, but will not be eligible for awards. This refers only to Champions. Ponies with a different rider, or riders with a different pony, are still eligible. . Each day, first through sixth place ribbons will be awarded for Open, AA, JR/YG (under 16) and JR/YG (17-21) at each level. . Scores from Friday and Saturday tests are averaged. Pony and small horse Champion and Reserve Champion through sixth place neck sashes will be awarded for Open, AA, JR/YG (under 16), and JR/YG (17-21) at all levels.

Page 7 National Dressage Pony Cup and Small Horse Championships Information

High Point Rider Awards: . The highest score for a ridden test on Friday or Saturday (excluding Musical Freestyles) will be used to determine results for Open, AA, JR/YG (under 16) and JR/YG (17-21) High Point Rider awards. . High Point and Reserve High Point will be awarded in each division. Breed Awards for Ponies and Small Horses: . The Breed Award celebrates the diversity of ponies and small horses represented each year at The National Dressage Pony Cup and Small Horse Championships. . The top two tests of the level are used for eligibility. Scores from Friday and Saturday will count (Musical Freestyle scores are not eligible). No additional classes need to be entered. . All breeds of ponies and small horses are eligible to compete. . The Grade Pony/Small Award is available for all measured ponies and small horses that do not belong to a registry. . Breed Awards for ponies and small horses whose registries have sponsored their Breed Award, include a neck sash and a choice of: a custom-sized embroidered wool cooler, a custom-sized embroidered mesh scrim sheet, or an embroidered stall banner. . Ponies and small horses whose breed registries did not sponsor their Breed Award will receive a neck sash from the NDPC. . To be eligible for Breed Awards, breed registration papers must be sent in with your entry or presented to the Pony Cup Show Office before the start of the show. . If no breed is declared, the pony or small horse will compete for the Grade Breed Award. . Degree of difficulty points (see the following chart) will be added to the average scores to determine the Breed Award champions. Degree of Difficulty Chart Level Points Added Level Points Addes Introductory 0 Third 8 Training 2 Fourth 10 First 4 FEI TOC 12 Second 6 FEI Pony 6

Rachel King Perpetual Trophy and Award: The Haflinger with the highest single score (with degree of difficulty points added) over both days will receive this award. There are no height requirements for this award. Breed papers must be submitted.

Neil Sorum Perpetual Trophy and Award: The Fjord with the highest single score (with degree of difficulty points added) over both days will receive this award. There are no height requirements for this award. Breed papers must be submitted.

Power Play Perpetual Trophy and Award: The Arabian pony with the highest single score (with degree of difficulty points added) over both days will receive this award. Freestyle scores included. Must be a pony and registered with the Arabian Horse Association (AHA). Breed papers must be submitted.

Page 8 National Dressage Pony Cup and Small Horse Championships Information

Young Pony Futurity: . The NDPC Young Pony Futurity recognizes the talents of young ponies as they progress through the levels. . The top two tests of Training, First, and Second Levels are competed for 4, 5, and 6 year old ponies, respectively. These tests are used for eligibility in Pony Cup AND for Futurity Awards. No additional tests are required to be ridden. . Nomination forms and a non-refundable $50 nomination fee must be made in advance of the competition start on Friday in order to be eligible for the Young Pony Futurity. . Awards will be given in three categories: 4 Year Old, 5 Year Old, and 6 Year Old Ponies. Awards will not be separated into rider divisions. . Scores from competition on Friday and Saturday will be averaged for the total score. . Ribbons will be given for first through sixth place. . Payback money will be given First through Fourth place. . 100% of the nomination fees will go into a combined purse, and will be awarded by the following percentages: o First - 40% o Second - 30% o Third - 20% o Fourth - 10% . An additional Born in the USA ribbon will be given to the highest scoring American born and bred pony at each level.

Pony Age Friday, July 20 Saturday, July 21 4 Year Old Training Level Test 2 Training Level Test 3 5 Year Old First Level Test 2 First Level Test 3 6 Year Old Second Level Test 2 Second Level Test 3

NDPC Prize Money: . Prize money will be awarded at all levels and divisions (Introductory through Grand Prix and Open/AA/YR/JR), for both pony and small horse divisions. . Champions will receive $250, Reserve Champions will receive $150. . Prize money will be given out within 30 days of the completion of competition. All prize money will be paid to the owner.

NDPC Competitors Dinner (Saturday night): . Each pony and small horse bridle number will receive one complimentary dinner ticket for the NDPC Competitor dinner to be held on Saturday evening at the Lamplight Equestrian Center. . Additional dinner tickets can be purchased with your entry for $25 each. Limited tickets available at the show office at Lamplight Equestrian Center for $35 each.

NDPC Awards Ceremony and Presentation: . The National Dressage Pony Cup Mounted Awards Ceremony for ponies, small horses, and NDPC Young Pony Futurity Awards will take place on Saturday evening before the Competitor’s dinner. . Times and details of awards ceremonies will be posted in the show office and on www.dressageponycup.com. . Champion through sixth place neck sashes and Futurity ribbons will be given to competitors at the show office when the final tests are signed for on Saturday. Competitors will be responsible for dressing their ponies and small horses in their ribbons prior to the awards ceremony. . Champion and Reserve winners are invited to participate in the Mounted Awards Ceremony. Ponies and small horses should be presented in full show attire with white or black polo wraps. . Breed Awards for ponies and small horses, the Rachel King, Neil Sorum, and Power Play Memorial Trophies, the Oldest Pony Award, and the High Point Rider Awards will be presented at the competitor’s dinner on Saturday evening at Lamplight Equestrian Center.

Page 9 National Dressage Pony Cup (NDPC) and Small Horse Championships Class Lists

Fri Sat Pony Cup Class Name Division Class USDF Q # # * indicates a GAIG/USDF Regional Qualifying class Fee Fee Introductory Level – Pony 501O USDF Intro B – Pony (Open) Open $40 501A USDF Intro B – Pony ( AA) AA $40 501Y USDF Intro B – Pony (17 – 21) JR/YG $40 501J USDF Intro B – Pony (16 and under) JR/YG $40 502O USDF Intro C – Pony (Open) Open $40 502A USDF Intro C – Pony-(AA) AA $40 502Y USDF Intro C – Pony (17 – 21) JR/YG $40 502J USDF Intro C – Pony (16 and under) JR/YG $40 Training Level - Pony 503O USEF Training Level Test Two – Pony (Open) Open $40 503A USEF Training Level Test Two – Pony (AA) AA $40 503Y USEF Training Level Test Two – Pony (17 – 21) JR/YG $40 503J USEF Training Level Test Two – Pony (16 and under) JR/YG $40 504O USEF Training Level Test Three – Pony (Open) * Open $40 $55 504A USEF Training Level Test Three – Pony (AA) * AA $40 $55 504Y USEF Training Level Test Three – Pony (17 – 21) * JR/YG $40 $55 504J USEF Training Level Test Three – Pony (16 and under) * JR/YG $40 $55 First Level - Pony 505O USEF First Level Test Two – Pony (Open) Open $40 505A USEF First Level Test Two – Pony (AA) AA $40 505Y USEF First Level Test Two – Pony (17 -21) JR/YG $40 505J USEF First Level Test Two – Pony (16 and under) JR/YG $40 506O USEF First Level Test Three – Pony (Open) * Open $40 $55 506A USEF First Level Test Three – Pony (AA) * AA $40 $55 506Y USEF First Level Test Three – Pony (17 - 21) * JR/YG $40 $55 506J USEF First Level Test Three – Pony (16 and under) * JR/YG $40 $55 Second Level - Pony 507O USEF Second Level Test Two – Pony (Open) Open $40 507A USEF Second Level Test Two – Pony (AA) AA $40 507Y USEF Second Level Test Two – Pony (17 - 21) JR/YG $40 507J USEF Second Level Test Two – Pony (16 and under) JR/YG $40 508O USEF Second Level Test Three – Pony (Open) * Open $40 $55 508A USEF Second Level Test Three – Pony (AA) * AA $40 $55 508Y USEF Second Level Test Three – Pony (17 - 21) * JR/YG $40 $55 508J USEF Second Level Test Three – Pony (16 and under) * JR/YG $40 $55 Third Level - Pony 509O USEF Third Level Test Two – Pony (Open) Open $40 509A USEF Third Level Test Two – Pony (AA) AA $40 509Y USEF Third Level Test Two – Pony (17 - 21) JR/YG $40 509J USEF Third Level Test Two – Pony (16 and under) JR/YG $40 510O USEF Third Level Test Three – Pony (Open) * Open $40 $55 510A USEF Third Level Test Three – Pony (AA) * AA $40 $55 510Y USEF Third Level Test Three – Pony (17 - 21) * JR/YG $40 $55 510J USEF Third Level Test Three – Pony (16 and under) * JR/YG $40 $55

Page 10 National Dressage Pony Cup (NDPC) and Small Horse Championships Class Lists

Fri Sat Pony Cup Class Name Division Class USDF Q # # * indicates a GAIG/USDF Regional Qualifying class Fee Fee Fourth Level - Pony 511O USEF Fourth Level Test Two – Pony (Open) Open $40 511A USEF Fourth Level Test Two – Pony (AA) AA $40 511Y USEF Fourth Level Test Two – Pony (17 - 21) JR/YG $40 511J USEF Fourth Level Test Two – Pony (16 and under) JR/YG $40 512O USEF Fourth Level Test Three – Pony (Open) * Open $40 $55 512A USEF Fourth Level Test Three – Pony (AA) * AA $40 $55 512Y USEF Fourth Level Test Three – Pony (17 - 21) * JR/YG $40 $55 512J USEF Fourth Level Test Three – Pony (16 and under) * JR/YG $40 $55 FEI Level - Pony 513O 514O FEI Test of Choice – Pony (specify test) (Open) * Open $50 $65 513A 514A FEI Test of Choice – Pony (specify test) (AA) * AA $50 $65 513Y 514Y FEI Test of Choice – Pony (specify test) (17 - 21) * JR/YG $50 $65 513J 514J FEI Test of Choice – Pony (specify test) (16 and under) * JR/YG $50 $65 FEI Pony (USEF Qualifying) 157 FEI Pony Team (USEF Qualifying) $65 257 FEI Pony Individual (USEF Qualifying) $65 Musical Freestyle - Pony USDF Freestyle – Pony (Open) * 515O 516O Open $50 $65 Specify test, TR to 4th. Training level not eligible for Q. USDF Freestyle – Pony (AA) * 515A 516A AA $50 $65 Specify test, TR to 4th. Training level not eligible for Q. USDF Freestyle – Pony (17 - 21) * 515Y 516Y JR/YG $50 $65 Specify test, TR to 4th. Training level not eligible for Q. USDF Freestyle – Pony (16 and under) * 515J 516J JR/YG $50 $65 Specify test, TR to 4th. Training level not eligible for Q. FEI Freestyle – Pony (Open) * 517O 518O Open $50 $65 Specify test, I1 or GP Freestyle FEI Freestyle – Pony (AA)* 517A 518A AA $50 $65 Specify test, I1 or GP Freestyle FEI Freestyle – Pony (17 - 21) * 517Y 518Y JR/YG $50 $65 Specify test, I1 or GP Freestyle FEI Freestyle – Pony (16 and under) * 517J 518J JR/YG $50 $65 Specify test, I1 or GP Freestyle

NOTE: Classes may not necessarily run in the order listed here.

Page 11 National Dressage Pony Cup (NDPC) and Small Horse Championships Class Lists

NOTE: Small horses will ride in the open show classes and then be placed in separate NDPC Small Horse classes.

Fri Sat Small Horse Class Name Divisions Class USDF Q # # * indicates a GAIG/USDF Regional Qualifying class Offered Fee Fee Introductory Level 102 USDF Intro B JR -YR / AA / Open $40 203 USDF Intro C JR - YR / AA / Open $40 Training Level 105 USEF Training Level Test Two JR - YR / AA / Open $40 206 USEF Training Level Test Three * JR - YR / AA / Open $40 $55 First Level 108 USEF First Level Test Two JR - YR / AA / Open $40 209 USEF First Level Test Three * JR - YR / AA / Open $40 $55 Second Level 111 USEF Second Level Test Two JR - YR / AA / Open $40 212 USEF Second Level Test Three * JR - YR / AA / Open $40 $55 Third Level 114 USEF Third Level Test Two JR - YR / AA / Open $40 215 USEF Third Level Test Three * JR - YR / AA / Open $40 $55 Fourth Level 117 USEF Fourth Level Test Two JR - YR / AA / Open $40 218 USEF Fourth Level Test Three * JR - YR / AA / Open $40 $55 FEI Level 126 226 FEI Test of Choice (specify test) * JR - YR / AA / Open $50 $65 Musical Freestyle USDF Freestyle * 124 224 $50 $65 Specify test, TR to 4th. Training level not eligible for Q. FEI Freestyle * 125 225 $50 $65 Specify test I1 or GP.

Page 12 National Dressage Pony Cup Breed Show Information

Measurement Requirements: Ponies under 3 years of age must show proof their Dam or Sire is a measured pony or a member of a pony breed registry. Ponies over 3 years of age must have a current USEF Pony Measurement card. Ponies 8 years and older will receive a permanent card. Ponies under 8 will receive a yearly/temporary card. Ponies without a current USEF Pony Measurement card must be measured before their first run. Pony measurements will be available to competitors on Thursday, July 19th. Indicate on your entry that you need your pony measured at the show and a time will be schedule for you on Thursday. Measurement fee is $35. NOTE: If you are only competing in the Breed Show on Sunday and need to be measured, contact the Show Secretary to see if any additional measurement times are available on Friday or Saturday. The show TD will provide pony competitors the USEF Pony Measurement forms. Ponies are to be presented in a halter with bridle number attached. Handler must be at least 18 years old. Ponies will be jogged in front of the show veterinarian. All measurement rules and requirements are governed by USEF.

Show Requirements: If the pony is only shown in-hand, the owner must either be a supporting member or member of the NDPC. If the pony is being ridden under saddle, the pony and rider must be members of the NDPC. Ponies and owners must be current members of USDF (or pay non-member fees). Ponies and owners must be current members of USEF in order to receive a Pony Measurement card. There are NO QUALIFYING SCORES required to enter.

Guidelines for Breed Show Competitors: Bridle numbers must be worn at all times when out of the stall. This includes non-competing ponies. Mares and stallions must stay on designated sides of the warm-up area. Colts of the current year accompanied by their dams must stay on the mare’s side of the warm-up area. One pony, one handler – ALWAYS – including mares with foals. All ponies age two and older must wear a bridle with an approved snaffle type bit. This applies to non-competing ponies as well. Handlers and Assistant Handlers are identified with wristbands. Only those properly identified persons will be allowed to accompany a pony into the competition area. Handlers and Assistant Handlers may carry one whip each. Assistant Handlers may carry a standard lunge or shorter whip. Whips may not have attachments of any type. Unauthorized assistance is forbidden under penalty of elimination. Any intervention by a third party with the object of facilitating the task of the competitor including voice, signals, etc., is considered illegal assistance. Loud snapping whips or other disruptive noise making devices are not permitted in the warm-up or competition areas. Boots or bandages of any kind are not permitted. Check in with the ring steward in charge of your competition arena. Remember that ponies, especially young ponies, react differently in new surroundings. Please stay alert for unpredictable behavior.

Some local rules may vary. Refer to the USEF Rule Book DR 201-211 for complete Dressage Sport Horse rules.

Page 13 National Dressage Pony Cup Breed Show Information, continued

In-Hand Triangle Procedure: In-hand classes will perform individually on the triangle measuring approximately 30 meters on each side, and 15 meters from B-C, or sized, if judge specifies, as described in USEF rule DR209. When called by the ring steward, follow the procedure as diagramed:

Stand pony at A for conformation judging.

Walk small triangle: A – B – C – A.

Trot large triangle: A – D – E – A.

Leave judging area promptly unless requested otherwise by the judge.

Definitions: Handler: Any person who holds, walks, or trots a pony while it is being judged in the competition arena for any In- Hand, Group, or Championship class. Handlers may have one Assistant Handler, if necessary. The Handler, Assistant Handler, and/or a whip assistant may each carry only one whip or one standard lungeing whip (without attachments, i.e. plastic bags, etc.) In addition, disruptive noisemaking devices are not permitted in the competition ring or warm-up areas. Prior to entering the competition arena, all Handlers and Assistant Handlers must have on file in the show secretary’s office a Handler/Assistant Release Form and must be wearing an appropriate wrist band. Handlers must be USEF members or pay the USEF non-member (Show Pass) fee.

Assistant Handler: Any person, other than the Handler, who holds or walks a pony in the competition arena during a class, whether or not it is being judged. An Assistant Handler is permitted only for call-backs after In-Hand or Group classes, for Championships, and for handling non-competition mares and foals that accompany another entry in the competition arena. Assistant Handlers may not show a pony at the trot, (except for ponies not being judged but accompanying a mare or foal that is being judged.) Only Handlers and Assistant Handlers may act as Whip Assistants. Assistant Handlers are not required to be USEF members or pay the USEF non-member (Show Pass) fee, but are subject to all other rules regarding Handlers.

Class Procedure: All competitors are responsible for understanding and complying with the current USEF Dressage/Sport Horse Breeding rules (Sub-Chapter DR-2.). Any pony entering the arena, whether being judged or not, must be controlled by a separate handler or assistant handler. NO PONY, INCLUDING FOALS, MAY BE SHOWN LOOSE. ONE PONY, ONE HANDLER AT ALL TIMES. In classes with 20 or more entries, the ponies with the top scores may be recalled as a group for re-evaluation. Championship Class procedure:-Ponies will be shown at the walk as a group and individually at the trot..

Page 14 National Dressage Pony Cup Pony Only Breed Show Class List

Sun # National Dressage Pony Cup Breed Show Class Name Class Fee Young Sport Pony Prospect Classes

Pony Fillies of 2018 – with or without Dam 1 $45 (Separate non-compete entry required for non-entered Mare. No fee for Mare.) 2 Pony Fillies – Yearling (2017) $45

3 Pony Fillies – Two Year Old (2016) $45

4 Pony Fillies – Three Year Old (2015) $45 Pony Colts/Geldings of 2018 – with or without Dam 5 $45 (Separate non-compete entry required for non-entered Mare. No fee for Mare.)

6 Pony Colts/Geldings – Yearling (2017) $45 7 Pony Colts/Geldings – Two Year Old (2016) $45

8 Pony Colts/Geldings – Three Year Old (2015) $45

National Dressage Pony Cup Breed Championships 9 Pony Current Year Foal Championships – open to 1st and 2nd place from classes 1 & 5 No fee

10 Pony Filly Championship – open to 1st and 2nd place from classes 2, 3, & 4 No fee

11 Pony Colts/Geldings Championship – open to 1st and 2nd place from classes 6, 7, & 8 No fee 12 Young Pony Championship – open to Champion and Reserve from classes 10 & 11 No fee

Mature Pony/Breeding Classes

13 Pony Four Year Old and Older Broodmares (in foal or nursing, mare only to be judged) $45 14 Pony Four Year Old and Older Maiden Mares (never bred) $45

Pony Four Year Old and Older Yeld Mares 15 $45 (have been bred in the past, but not currently bred or nursing) 16 Pony Four Year Old and Older Stallions $45

National Dressage Pony Cup Breed Championships

17 Pony Mare Championship – open to 1st and 2nd place from classes 13, 14, & 15 No fee

18 Pony Stallion Championship – open to 1st, 2nd, and 3rd place from class 16 No fee

19 Pony Mature Horse Championship – Champion and Reserve from classes 17 & 18 No fee

20 Pony Grand Championship – Champion and Reserve from classes 12 and 19 No fee

NOTE: These classes are not USDFBC Qualifiers. For a chart explaining how these Breed Show classes progress, see http://www.dressageponycup.com/breed-show.html

National Dressage Pony Cup Pony Only Breed Show Class List

Sun # National Dressage Pony Cup Breed Show Class Name Class Fee Pony Under Saddle Classes

21 Pony Materiale Three Year Old Fillies $40

22 Pony Materiale Four and Five Year Old Mares $40

23 Pony Materiale Three Year Old Colts/Geldings $40

24 Pony Materiale Four and Five Year Old Geldings/Stallions $40

25 Suitable to Become a Dressage Pony $40

Pony Individual Breed Classes

27 North American Sport Pony Registry - Pony $45

28 American Haflinger Registry - Pony $45

29 Society of North America - Pony $45

30 Arabian Sport Horse Alliance - Pony $45

31 Association - Pony $45

32 ISR Oldenburg Registry & Weser-Ems - Pony $45

33 Fell Pony Society of North America - Pony $45

34 Norwegian Fjord Horse Registry - Pony $45

35 American Connemara Pony Society - Pony $45

36 Rheinland Pfalz-Saar International - Pony $45

37 $45 Nederlands Rijpaarden en Pony Stamboek (NRPS) - Pony 38 Association - Pony $45

39 Gypsy Horse Registry of America - Pony $45

Pony Individual Breed Classes: The Pony Individual Breed Classes (IBC) are for ponies of the same breed or breed registry, per USEF rule DR 204.2. Ponies must have a valid USEF Measurement Card in order to complete in these classes. These classes are open to ponies of any age provided a copy of the breed registration has been included with the entry. All classes listed are for ponies registered with the breed organization and owners must be members in good standing of that organization. Please submit a copy of the registration papers with your entry. Show management will determine eligibility. Incomplete entries will not be accepted. Ponies to be shown in‐hand and to move at the judge’s discretion.

□ PONY DIVISION □ SMALL HORSE DIVISION

MEMBER INFORMATION: Name: ______Address: ______City/ST/Zip: ______Email: ______Phone: ______Date of Birth: ______

Rider Status: ⃝ Junior (16 and under) ⃝ Young Rider (17 to 21) ⃝ Adult Amateur ⃝ Open Will you be competing at Introductory Level? ⃝ Yes ⃝ No

MEMBERSHIP FEES: TOTAL Base Membership Fee $40, Additional $10 Activation Fee Per Pony/Horse $40

Name: ______Breed: ______Date Foaled: ______

1 /HORSE Owner: ______$10 Owner Email: ______

PONY Pony/Horse USEF Number: ______

Name: ______Breed: ______Date Foaled: ______

/HORSE Owner: ______Owner Email: ______

PONY Pony/Horse USEF Number: ______

Name: ______Breed: ______Date Foaled: ______

/HORSE Owner: ______Owner Email: ______

PONY Pony/Horse USEF Number: ______

Name: ______Breed: ______Date Foaled: ______

/HORSE Owner: ______Owner Email: ______

PONY Pony/Horse USEF Number: ______You may pay by check, PayPal (with email provided above), TOTAL: $ or credit card (by phone).

· Use multiple forms for more than four ponies/small horses. · Ponies, small horses, and riders must be registered annually and may be added until end of each competition year. · Copy of USEF Pony Measurement Card or NDPC Small Horse Measurement Form must be in NDPC office by October 31st. · Membership Fee includes eligibility for Member Only NDPC Year-End Awards. · To be eligible for Member Only NDPC Year-End Awards, each pony/small horse must be activated for each rider. · Owner does not need to be a member, only the rider. · Membership is valid for the 2018 competition year; from November 1st, 2017 to October 31st, 2018.

Questions? Contact us at (513) 290-8070 or [email protected]

Mail this completed form with payment information to: National Dressage Pony Cup, P.O. Box 18272, Cincinnati, OH 45218-0272

Page 18

YEAR: ______

PONY INFORMATION: Pony Name: ______Breed: ______Birth Date: ______Sire: ______Dam: ______Breeder: ______Division: ⃝ 4 Year Old ⃝ 5 Year Old ⃝ 6 Year Old

OWNER INFORMATION: Owner Name: ______Address: ______City/ST/Zip: ______Email: ______Phone: ______

FEE: $50

(You may pay by check or PayPal.)

Please Note: Must submit a copy of Breed Papers with Nomination Form.

Questions? Contact us at (513) 290-8070 or [email protected]

Mail this completed form with payment information to: National Dressage Pony Cup, P.O. Box 18272, Cincinnati, OH 45218-0272

COMPANY NAME:

CONTACT NAME:

BILLING ADDRESS:

EMAIL:

PHONE:

NATIONAL DRESSAGE PONY CUP AND SMALL HORSE CHAMPIONSHIPS

COMPETITOR’S DINNER MEASUREMENTS Pony & Small Horse Measurements: Full Dinner: $7,000 $1,500

SPONSOR A PONY OR SMALL HORSE CLASS

Pony Pony Pony Pony Pony Pony Pony Pony Pony Classes: Intro Training First Second Third Fourth FEI TOC Freestyle $500 each

Small Horse Small Horse Small Horse Small Horse Small Horse Small Horse Small Horse Small Horse Small Horse Classes: Intro Training First Second Third Fourth FEI TOC Freestyle $500 each

BANNER SPACE GENERAL SPONSORSHIP Full Show: $75 Amount: $______

SPECIALTY AWARD/PERPETUAL TROPHY Sponsor Name(s): $800 + $200/year Award Name/Description:

DONATE RAFFLE PRIZES Sponsor Name(s): Raffle Description/Value:

GRAND TOTAL: $ We accept Checks or PayPal If you would like to pay by credit, please call us!

Mail this completed form with payment information to: National Dressage Pony Cup, P.O. Box 18272, Cincinnati, OH 45218-0272

COMPANY NAME:

CONTACT NAME:

BILLING ADDRESS:

EMAIL:

PHONE:

NATIONAL DRESSAGE PONY CUP AND SMALL HORSE CHAMPIONSHIPS

COMPETITOR’S DINNER MEASUREMENTS Pony & Small Horse Measurements: Full Dinner: $7,000 $1,500

SPONSOR A PONY OR SMALL HORSE CLASS

Pony Pony Pony Pony Pony Pony Pony Pony Pony Classes: Intro Training First Second Third Fourth FEI TOC Freestyle $500 each

Small Horse Small Horse Small Horse Small Horse Small Horse Small Horse Small Horse Small Horse Small Horse Classes: Intro Training First Second Third Fourth FEI TOC Freestyle $500 each

BANNER SPACE GENERAL SPONSORSHIP Full Show: $75 Amount: $______

SPECIALTY AWARD/PERPETUAL TROPHY Sponsor Name(s): $800 + $200/year Award Name/Description:

DONATE RAFFLE PRIZES Sponsor Name(s): Raffle Description/Value:

GRAND TOTAL: $ We accept Checks or PayPal If you would like to pay by credit, please call us!

Mail this completed form with payment information to: National Dressage Pony Cup, P.O. Box 18272, Cincinnati, OH 45218-0272 Both pages of the vendor application, rules, regulations, and polices must be signed, initialed and returned together with the deposit.

2018 Vendor Rules, Regulations, and Polices

Please read and initial each article. ______Payments: a 50% deposit is required with application, and the final payment will be processed on day of set up. ______Space Assignments: will be made for applications received and approved on a “space available” basis, length of stay and size of space requested. ______Initial Setup: Each vendor is responsible for scheduling arrival with the vender department. Weekly set-up will be from 9am to 5pm prior to show start. No vendor set-up during the Horse Show. If you are assigned a space facing a horse only lane, you must have your vehicle or cart cleared from the lane 30 minutes before the show starts. *********************** All horses have the right of way *********************** ______Early Arrivals: early arrivals will be charged accordingly. ______Signage: vendor signs must not block horse or pedestrian paths. No pole banners or flags that move/wave on booths facing the horse only paths. ______Parking: vendors and their representatives must use the upper or lower guest parking lots. No parking behind show office and or farm house. ______Security: to safeguard vendor’s property either during the show or after show hours is the vendor’s responsibility. All property left in the booth during the show or after the show will be left at the vendor’s risk. ______Shipping and Receiving: under no circumstances will Lamplight Equestrian Center be responsible for packages or merchandise ship to prior to the vendors set up date. Contact by email or phone if you have any questions. ______Certificate of Insurance: All vendors will be required to have a certificate of insurance (Acord Form #25) showing. General Liability Insurance policy ($1,000,000) naming Lamplight Equestrian Center as additional parties, effective from set up to break down. ______Tents: No “Pop-up” tents or wooden pallets for flooring are allowed. ______Cancelation and Refunds: Must be done by email 5 days prior to your scheduled arrival date, for a deposit refund.

I have read the Term and Conditions of this Vendor application and BY SIGNING BELOW, I AGREE to be bound by all Terms and Conditions of this Vendor application, and further agree to indemnify and hold harmless, Lamplight Equestrian Center and its affiliates, its officers, employees, and agents from all costs, liabilities, attorney’s fees, judgments, and expenses incurred because of or arising out of any claim, assertion, or legal proceeding concerning my obligations under this contract and form any all claims for injury or loss suffered during or in conjunction with any of the horse show during which I will be a Vendor and for any and all claims arising out of Lamplight Equestrian Center management of these shows.

Company Name (Print): ______

Name (Print): ______

Signature: ______Date:______

Page 22 Page 23 General Regulations, Policies and Entry Specifications:

EVERY CLASS OFFERED HEREIN WHICH IS COVERED BY THE RULES AND SPECIFICATIONS OF THE CURRENT FEDERATION RULE BOOK WILL BE CONDUCTED AND JUDGED IN ACCORDANCE THEREWITH.

US EQUESTRIAN FEDERATION rules are in force from the moment show management allows access to the showgrounds. This includes conduct, correct saddlery and equipment, and attire.

Liability – Horses by their inherent nature present a risk. This show, the management, the USEF Licensee, and the facility will not be responsible for any loss or damage or injury to horses exhibited, or for any article of any kind or nature that may be lost or destroyed, or in any way injured. Each exhibitor will be responsible for any injury that may be occasioned to any person, whomsoever, by any horse owned or exhibited by said exhibitor and shall indemnify the show, the management, the show committee and volunteers, the USEF Licensee, the USEF and USDF, or any member thereof, against all claims and demands, of any nature or kind, that may grow out of any injury occasioned by any horses owned or exhibited by them, or arise from the negligence of the person in charge of any such horse. All horses exhibited in this show participate entirely at the owner’s risk. Neither the Organizing Committee, show volunteers and staff, the facility or its owners, 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

Additionally, Lamplight Equestrian Center, and their officials, sponsors and employees will not be responsible for any accident or loss which may occur to any exhibitor, spectators, guest, rider, groom, attendant or other employee, animal or equipment at any of the competition.

USEF Membership Statement (GR901.9) Life, senior active and junior active members shall be eligible to participate in all classes at Regular Competitions, Competitions at the Preliminary Level or above and 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 (exception: Friesian performance FR222) 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.

Exhibitors should exercise extreme caution before medicating their horses and should be aware of the US EQUESTRIAN FEDERATION rules governing drugs and medications. Any questions about the use of certain medications and regarding Rule IV should be directed to the USEF Federation Equine Drugs and Medications Program, 956 King Avenue, Columbus, Ohio 43212‐2655. (800) 633‐2472, (614) 299‐7707, FAX (614) 299‐7706.

A trainer is defined as any adult who has responsibility for the horse on the competition grounds and must sign the entry form.

Protective Headgear Rule: 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‐competing horses and those competing in all classes and tests must wear protective headgear as defined by this rule and otherwise in compliance with GR801. Any rider violating this rule at any time must be immediately prohibited from further riding until such headgear is properly in place. Protective headgear is defined a riding helmet which meets or exceeds ASTM (American Society for Testing and Materials)/SEI (Safety Equipment Institute) standards for equestrian use and carries the SEI tag. The harness must be secured and properly fitted.

Musical Freestyles: Music must be on good quality CD and must be presented to the announcer at least two hours before scheduled ride. The schedule for sound checks will be posted at the show.

Bridle Numbers: Bridle numbers must be worn at all times when a horse is being exercised or ridden.

No Shows: All “No Shows” that have not contacted the show office will be considered a scratch for the rest of the show and time slots may be filled. Exhibitors enter with this understanding and agreement.

Page 24 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.

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.

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. All entries for Open Classes are taken on a first come, first served basis. Only one horse‐rider combination per entry form.

Opportunity Classes: Opportunity classes are intended for entry level riders. Horses and riders entered only in “Opportunity” classes are exempt from USEF and USDF membership requirements, and do not have to pay non-member (show pass) or HID fees. Federation and drug fees do not apply. Horses entered only in these classes are still subject to and must comply with the Drugs and Medication rules and are subject to drug testing. Riders and/or horses entered in “opportunity” classes may not cross enter into other recognized classes at the show. Participants must abide by all USEF regulations pertaining to attire, tack and equipment for the recognized show. See USEF rule GR821 for additional information.

Sharps Disposal: 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. Containers are located at the end of each barn aisle and within center aisles when center aisles are present within the barns.

Dogs: Facility rules require that dogs must be on a leash (not to exceed 6 feet in length) or suitably restrained in a tack stall/cage etc. Loose animals/animals left in vehicles in distress, etc. can and will be removed from the grounds at the owner's expense.

Membership/Registration Requirements for GAIG/USDF Qualifying Classes: Riders must be current USDF Participating members & USEF members (Junior, Senior or Life) in good standing. Horses must be USDF Lifetime Registered and USEF Annual or Lifetime Recorded. Horses with only an HID are not eligible. Owners must be current USDF Participating or Business members & USEF members (Junior, Senior or Life) in good standing. For current Great American/USDF Championship requirements, go to www.usdf.org/competitions/competitionschampionships/regionals/index.asp.

Show Schedule and Ride Time Conflicts: It is the responsibility of the rider to inform the management of any time conflicts as soon as possible after receiving the schedule. Changes need to be requested in the show office by 3pm the day prior.

FEDERATION ENTRY AGREEMENT 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, cablecasts, 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 USEF rule GR908.4.

Current Rules: The rules may have changed from the current USEF Rule Book. It is the competitor's responsibility to check the current USEF Rule Book for any changes. Current rules can be found on www.usef.org.

Page 25 This USDF Membership Benefits: USDF is dedicated to education, the recognition of achievement, and promotion of dressage. For details competition on member benefits, including educational programs, awards, and other opportunities, refer to the USDF Member Guide or the USDF is recognized website at www.usdf.org. by USDF Membership Requirements for USEF-licensed/USDF-recognized Competitions: Owners and riders, including foreign riders and for 2018 owners who are not residents of the US, wishing to participate in a USEF-licensed/USDF-recognized competition as a rider or owner/lessee, must have either a USDF Group Membership (GM), Participating Membership (PM), or have a USDF Non-Member (NM) identification number and pay the USDF Non-Member (NM) fee. (Note: USDF Business Members can own horses but cannot compete as riders with their USDF Business Membership.) Individuals cannot compete at a USEF-licensed/USDF-recognized competition with a USDF Education Membership. Horses competing at USEF-licensed/USDF-recognized competitions must have either a USDF Horse Identification (HID) number or a USDF Lifetime Horse Registration (LHR). Proper credentials or verification certificates must be presented to the competition secretary. Riders and owners wishing to participate in a USEF-licensed/USDF-recognized competition, and not able to present the competition secretary with verification of a USDF membership or NM identification, and USDF LHR or USDF HID, must complete a USDF Competition Affidavit Form and pay the $5 affidavit filing fee. A copy of a completed affidavit form from another competition may also be used for verification purposes for up to 60 days. (Exception: Affidavits cannot be used at Great American Insurance Group/USDF Regional Dressage Championships.) Exceptions:  Horses competing only in Individual Breed Classes (IBCs) at DSHB competitions, sires and dams of horses in DSHB group classes, where those sires or dams are not actually competing in the same competition, horses competing only in breed restricted dressage or DSHB classes at Regular Competitions (e.g. all Arabian, all Friesian, or all Morgan classes), or in USDF Introductory Level tests, pas de deux or quadrille, are exempt from this requirement. Also exempt are horses ridden in leadline, exhibitions, games and races, classes for 4-H members, walk-trot, academy, and opportunity classes.  Riders and owners/lessees competing only in classes which are exempt from the USDF HID requirements are also exempt from the USDF NM identification number and NM fee requirements. Also exempt are handlers of horses competing in DSHB In-Hand or Group classes.

Memberships Defined Participating Membership (PM): A membership issued to an individual directly by USDF. The membership year is December 1 through November 30. PMs are available for 1-year ($90), 5-years ($360), or life ($1,800). A USDF Youth Participating Membership (YPM) is available for individuals who have not reached their 21st birthday by December 1 of the current membership year ($72). A PM allows the member to compete at USEF-licensed/USDF-recognized competitions and to participate as a rider and/or owner/lessee for all Adequan®/USDF Year-End Awards, USDF Breeders Championship Series Finals and the Great American Insurance Group/USDF Regional Dressage Championship program. Group Membership (GM): A membership issued to an individual by USDF when the member name and dues are submitted to USDF through an affiliate Group Member Organization (GMO). The GM year begins December 1 and ends November 30. A GM allows the member to compete at USEF-licensed/USDF-recognized competitions and participate in the USDF Rider Awards program. Business Membership (BM): A membership that runs December 1 through November 30 and is issued to a business or organization directly by USDF. The USDF BM ($240) offers a wider variety of advertising benefits. BMs satisfy requirements of horse ownership only. Education Membership (EM): A membership issued to an individual directly by USDF. This online education only membership expires 12 months after the date joined. This membership type does NOT allow an individual to compete at a USEF-licensed/USDF-recognized competition. Non-Member (NM) Identification Number: For each USDF NM owner/lessee and USDF NM rider there will be a USDF NM fee of $35 per competition that must be collected by the show secretary and submitted to USDF, along with the USDF Report of Fees document and the $5 affidavit fee and Competition Affidavit Form if the person cannot provide a copy of their USDF NM card. Owners/lessees or riders exempt from the NM number requirements are also exempt from paying the USDF NM fee. If there are multiple owners of a horse and all are NMs, only one of the owners must pay the NM fee. If the horse has at least one owner who is a current USDF PM, GM, or BM there is no NM fee assessed. Competition management will be invoiced for all applicable USDF NM fees not received with the USDF post- competition paperwork, along with a report listing all USDF NMs. Competition management is then required to submit the NM fees within 30 days to the USDF. An individual with a USDF NM identification number is not eligible for any USDF membership benefits. Once a USDF NM number has been assigned, a USDF NM card can be obtained from the USDF website. Horse Identification (HID) Number: A one-time tracking number for horses ($35). Scores earned by a horse with an HID number will be recorded, but will NOT be counted towards Adequan®/USDF Year-End Awards. A horse with an HID number is not eligible to compete in Great American Insurance Group/USDF Regional qualifying or championship classes or USDF Breeders Championship Series Finals. An HID number can be upgraded to a Lifetime Horse Registration (LHR) for a fee of $80. If a horse has a USDF LHR it does not need an HID number. An HID number is a one-time fee that does not need to be renewed. Lifetime Horse Registration (LHR): A horse with an LHR ($115) is eligible for Adequan®/USDF Year-End Awards, and eligible to compete at USDF Breeders Championship Series Finals and Great American Insurance Group/USDF Regional qualifying and championship classes, assuming requirements for the owner and rider are met. If a horse has an LHR it does not need an HID number. An LHR does not need to be renewed.

How to Join USDF Applications for USDF Participating Membership (PM), Business Membership (BM), Horse Identification (HID) number, and Lifetime Horse Registration (LHR) may be found in the following locations:  On the USDF website: www.usdf.org. You can submit the application online or download the form and fax or mail it to the USDF office.  In the show office at USEF-licensed/USDF-recognized competitions classified by USEF as Dressage Competitions, and Regular Competitions which are open to all breeds.  By calling or writing the USDF office at (859) 971-2277, 4051 Iron Works Parkway, Lexington, KY 40511

The effective date of membership is the date the form and correct fees are received in the USDF office or, if applying at a competition, the date accepted by the competition secretary, provided the application is signed and dated by the competition secretary, member, and/or horse owner on that same day.

01/17

Page 26 2018 Great American Insurance Group/USDF Regional Dressage Championships

A single Regional Dressage Championship program organized by the United States Dressage Federation (USDF), 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 USDF website at www.usdf.org. Please refer to the 2018 USDF Member Guide for the comprehensive list of rules and requirements for this program.

Membership/Registration Requirements for Qualifying and Championships All memberships and registrations/recordings must be correct and current at the time qualifying scores are earned and at the time of the championships. Rider:  Must have a USDF Participating* Membership (PM).  Must have a USEF membership (Junior Active, Senior Active, or Life). Horse:  Must have a USDF Lifetime Horse Registration (LHR).  Must have a USEF (Annual or Lifetime) Horse recording.  USDF 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 Participating or Business Membership and a USEF membership (Junior Active, Senior Active, Life, or Recorded Farm (with Active Farm Owner)). If the horse has more than one owner, at least one owner must have both active USEF membership and active USDF Participating or Business Membership. For a business or farm to be the valid owner under this requirement, it must be listed as an owner of the horse with both USEF and USDF. * 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 Training Level 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 AA JR/YR Training Level (Test 3) 68% 63% 63% First Level (Test 3) 66% 62% 62% Second Level (Test 3) 64% 61% 61% Third Level (Test 3) 62% 60% 60% Fourth Level (Test 3) 62% 60% 60% FEI Junior (Team Test) — — 60% FEI Young Rider (Team Test) — — 60% Prix St. Georges 60% 60% 60% Intermediate I 60% 60% 60% Intermediate II 60% 60% 60% Grand Prix 60% 60% 60%

FREESTYLE OPEN AA JR/YR First Level 63% — — Second Level 63% — — Third Level 63% — — Fourth Level 63% — — Intermediate I 63% — — Grand Prix 63% __ __

Rev Aug 2017

Page 27 Page 28 Page 29 Official Use Only 2018 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

EMAIL ADDRESS

RIDER CITIZENSHIP (IF NOT USA )

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

USEF# USDF# LOCAL# Subtotal of Class Fees & Qualifying Fees ADDRESS USEF Non-Member Fees - $45 Per Non-Member CITY/ST/ZIP USDF Non-Member Fees - $35 Per Non-Member CELL PHONE Office Fee EMAIL ADDRESS USEF Drug Fee - $23/horse OWNER CITIZENSHIP (IF NOT USA )

TRAINER Email/Fax Fee - $10/entry

USEF# USDF# LOCAL# Wayne Tax Fee - $12.50/weekend

ADDRESS Stabling Fees Stalls @ $ /Stall

CITY/ST/ZIP Tack Stall Fees Stalls @ $ /Stall

CELL PHONE Bedding Bag @ $ /Bag

EMAIL ADDRESS Non-Competing Horse Fee

COACH Late Fee

USEF# USDF# LOCAL# RV Camping Fees - $50/night

ADDRESS Other Fees

CITY/ST/ZIP Credit Card Conveniece Fee - $5/entry

Please Fill Out Both Sides of This Form. Reverse side MUST be SIGNED. 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: Page 30 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 11/14/2013

OWNER’S/AGENT’S SIGNATURE RIDER/HANDLER SIGNATURE TRAINER’S SIGNATURE COACH’S SIGNATURE (MANDATORY) (MANDATORY) (MANDATORY) (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

Page 31