USEF 2011 National Youth Championship & SmartPak North American Junior/Young Rider Reining Championship CRIY* Selection

Held in conjunction with the 2011 NRHA Derby June 27- July 2, 2011

Oklahoma State Fairgrounds Oklahoma City, OK USEF National Reining Championship, CRI-Y June 27 – July 2, 2011

Officials

Judges: Joe Hayes (USA) – President of Jury Bub Poplin (USA) LaRae Powell (US National Level Judge) - Equipment

President of the Organizing Committee: Melanie Rinehart USEF Steward: Eric Straus FEI Veterinarian: Dr. Ray Randall Show Veterinarian: Dr. Alan Donnell Ferrier: Phillip Chamberlain Announcer: Glen Gabel Medical Staff: Equestrian Medical Services Photographer: Waltenberry, Inc. Videographer: Video World Concessions Provided By: Ovations

Competition Manager: Melanie Rinehart - NRHA E-mail: [email protected] Business Phone: 405.946.7400 On-site Phone: (same)

Competition Secretary: Leigha Stevenson - NRHA Email: [email protected] Business Phone: 405.946.7400 On-site Phone: (Same)

Mail Entries To: Facility Address:

NRHA, Attn: USEF Entries Oklahoma State Fairgrounds 3000 NW 10th Street 333 Gordon Cooper Blvd. Oklahoma City, OK 73107 Oklahoma City, OK 73107 Phone: 405.946.7400 Phone: 405.946.7400 Fax: 405.946.8425 Fax: 405.946.8425

Licensee: National Reining Horse Association

Executive Director: Dan Wall

For all qualification questions contact: Vonita Bowers Director of Endurance and Reining Activities The United States Equestrian Federation 4047 Iron Works Parkway Lexington, KY 40511 Direct # (859) 825-6001 Main Line (859) 258-2472 FAX (859) 231-6662 [email protected] USEF National Reining Championship, CRI-Y June 27 – July 2, 2011

Tentative Schedule of Events

June 27-July 2 – National Level (NRHA) Classes

Friday, July 1: 8:00am CRI-Y Vet Examination and Passport Control – FEI Secured Stable 10:00am USEF-CH & CRI-Y Horse Inspection (Jog) – Arena 3 *followed by the USEF/CRI-Y Draw

Saturday, July 2: Following NRHA Youth classes USEF National Youth Reining Championship – Adequan Arena

Note: USEF & FEI runs will occur in the second section for the day, estimated to begin at roughly 1pm, watch the progress of the morning session and listen for announcements to find the exact time of this section of competition.

Additional schooling times, rider meetings and draws will be published at the event for all participants

USEF/FEI - CRI Deadlines: Entries in Principle: 24.06.11

Nominated Entries: 24.06.11

Definite Entries: 24.06.11

Last date for substitutions: 25.06.11 see FEI rules on subs.

Entry Fees:

USEF-CH(R) & CRI-Y, $50 USD (Concurrent with USEF Youth)

Stall Fees:

CRI Horse Stall in FEI Secured Stabling – $250 USD

Regular Stall for entries in USEF Championship Classes Only – $175 USD

Additional stalls (for tack or misc.) - $175 USD

USEF National Reining Championship, CRI-Y June 27 – July 2, 2011

All athletes are strongly encouraged to take the time to thank SmartPak for their continued support of these important programs and competitions. They have been long-time supporters of USEF Reining as well as NRHA and FEI events around the nation and around the world. They have been an invaluable resource for our sport. If you pass a SmartPak representative while at the NRHA Derby, or at any of the shows and events that they attend, please extend your gratitude for the ability to offer these types of classes.

USEF National Reining Championship, CRI-Y June 27 – July 2, 2011

Hotel Information:

Mention NRHA Derby to obtain special rates

Cambria Suites - $89 Hilton Garden Inn - $95

th 4410 SW 19 St 801 S Meridian

Oklahoma City, OK 73108 Oklahoma City, OK 73108

405-688-3300 405-942-1400

Best Western Saddleback Inn - $89.99 Embassy Suites - $114

rd 4300 SW 3 St 1815 South Meridian

Oklahoma City, OK 73108 Oklahoma City, OK 73108

405-947-7000 405-682-6000

*Additional hotels can be found at nrhaderby.com

Rules & Regulations:

1) In addition to the Rules and Regulations listed here, the terms and conditions, rules and regulations for the NRHA Derby, the USEF, FEI and NRHA shall also apply, where applicable.

2) EVERY CLASS OFFERED AT THE USEF NATIONAL REINING CHAMPIONSHIP WHICH IS COVERED BY THE RULES AND SPECIFICATIONS OF THE CURRENT USEF RULE BOOK WILL BE CONDUCTED AND JUDGED IN ACCORDANCE THEREWITH.

3) All questions not covered in these rules and regulations shall be decided by the show management whose decision shall be final.

4) Every horse entered for competition will comply with the rules of the management, but management will, in no case, be responsible for any loss or damage that may occur, and it shall be condition of entry that each exhibitor shall hold this horse show and the officials and employees of the show blameless for any loss or accident to his horse, employees, equipment, which may occur from sickness, fire or otherwise. All owners and competitors are personally responsible for damages to third parties caused by themselves, their employees, their agents or their . 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.

5) The management reserves the right to refuse, accept conditionally, or to cancel any entries, disqualify any riders or exhibitors, prohibit entries and cancel award prizes without claims for damages; to cancel or combine unfilled classes, or to reschedule classes after due notice to exhibitors; to change rings or rotate judges.

6) Exhibitors are notified that any act of discourtesy or disobedience to the judges or officials, on the part of the owner, manager, rider, or groom shall disqualify the horse, and the owner shall forfeit his entry fee and other fees. USEF National Reining Championship, CRI-Y June 27 – July 2, 2011

7) Show management reserves to itself the power to prohibit any person from attending or showing a horse in the ring and to remove any groom or horse from the show without being liable for compensation.

8) In accordance with the 1989 Federal Waste Tracking Act, which restricts the disposal of medical waste, bio-hazardous medical waste containers will be provided in the stable area. All exhibitors and their agents are responsible for the proper disposal of this waste.

9) No person will be allowed in the show ring during the time of judging except the exhibitor and those having official or requested duties to perform.

10) It is the tradition of the show that riders be correctly attired for the class in question, that attendants be neatly dressed and the horses properly presented. Management may in its discretion bar any person from entering the ring if not suitably presented to appear before an audience.

11) USEF MEMBERSHIP STATEMENT - 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 Combined Competitions at the Advanced Level, , 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 Competitions upon payment of a $30 nonmember registration fee. Participants in the following classes are exempted from the Requirements of this rule:

1) leadline; 2) exhibitions; 3) games and races; 4) classes for 4-H members; 5) walk trot and academy classes (academy classes are classes limited to horses used regularly in a lesson program); 6) USDF introductory level tests, pas de deux and quadrille classes; 7) NRHA Endorsed Reining Competitions. 8) Opportunity classes, 9) citizens of other nations who have proof, in English, of current membership in good standing of their own National Federation, USEA beginner novice division; and 10) assistant handlers.

12) Minors who do not have a valid driver’s license which allows them to operate a motorized vehicle in the state in which they reside will not be permitted to operate a motorized vehicle of any kind including, but not limited to, golf carts, motorcycles, scooters, or farm utility vehicles on the competition grounds of licensed competitions. Minors who have a valid temporary license may operate the above described motorized vehicles as long as they are accompanied by an adult with a valid driver’s license. Violations of this rule will be cause for sanctions against the parent(s), guardian(s) and/or trainer(s) who are responsible for the child committing the offense. Penalties may include exclusion of the child, parent(s), guardian(s), and/or trainer(s) from the competition grounds for the remainder of the competition and charges being filed against any of the above individuals in accordance with Rule 6. Wheelchairs and other mobility assistance devices for individuals with disabilities are exempt from this rule.

13) Entries: Shall be accepted up to the point that the class is drawn for the starting order or in the event of the CRI, for the veterinarian’s examination of the horse and the beginning of passport control. Each entry must complete the enclosed entry form including all required numbers and signatures.

14) Prize Money: When applicable, prize money shall be paid out within 30 days of the close of the competition.

All riders will be judged by two FEI Reining Judges. The two scores will be combined for the Competitor’s total score. Competitor with the highest score shall be declared champion of the respective class, and so on. Competitors shall be placed subsequently based on the sum of the scores. Ties shall be broken according to the tie-breaking formulas outlined in the FEI Rules for Reining. USEF National Reining Championship, CRI-Y June 27 – July 2, 2011

Prizes:

USEF National Championships: USEF National Champion Medals

th CRI- Y, Ribbons to 6 place and qualification to advance to the NAJYRC

Prize-giving Ceremony:

All Competitors are asked to return to the arena astride their horses and in show attire for the prize-giving ceremony. For all three competitions: First through Third plus ties for Third shall be awarded on the official podium. All other prizes shall be given in a manner that is traditional and explained prior to distribution, when applicable.

Deductions from Prize Money:

Competitors of US Citizenship and Foreign Competitors with a United States of America IRS Tax Identification Number are required to complete a W9 Form.

Competitors who claim residence outside of the USA, or is a Non-Resident Alien Individual, be advised that the IRS requires sporting events to withhold 30% of prize money won in the USA. Foreign competitors should apply for a US Tax Identification Number and will be asked to complete form 8283 or complete a W8 Certificate of Foreign Status Form. Both of these forms are available in the horse show office or they can be easily e-mailed to you by the organizing committee.

15) Refunds: There shall be no refunds for scratches without an official vet certificate indicating loss of serviceability of the entered horse. Instances of illness of the rider and inclement weather will be considered on a case-by-case basis by the show manager. Show manager’s decision is final. CRI Entries: Withdrawals after the date of definite entries or no-shows will be held liable to reimburse the OC for the actual financial loss incurred by the OC as a result of the late withdrawal or no-show.

16) Stabling: The Oklahoma State Fairgrounds offers plentiful and state-of-the-art stabling facilities. All stalls are at least 10’ X 10’ and are permanent. Doors are provided. The entry will be stalled with the submission of an entry form. Additional stalls can be ordered through the NRHA Stall Reservation Form, which is attached to this prize list. Stall prices and upgrade/patron opportunities are outlined on this form. Stalls availability (arrival and departure information) is also outlined on this form.

17) Health Requirements: 30-day Veterinary Certificate of Heath and 12-month Negative Coggins Test (AGID or Elisa) are required and must be presented prior to unloading of horses into stable.

Any animal with an origin from a recognized county, province or state with current quarantine for Vesicular Stomatitis will be required to present a Veterinary Certificate that is issued less than 48 hours prior to the time or arrival and will also be required to present the animal for visual inspection by the show veterinary.

Any animal with an origin from a recognized county, province or state with current quarantine for Equine Herpes Virus will be required to present a Veterinary Certificate that is issued less than 48 hours prior to the USEF National Reining Championship, CRI-Y June 27 – July 2, 2011

time or arrival and will also be required to present the animal for visual inspection by the show veterinary.

Animals from VS and EHV quarantined counties, provinces or states may be subject to specialized quarantine stalls within the secured stable area.

18) Import/Export Services: Competitors in need of International Customs and Transport Services, please contact: Nedpoint Transportation Services, Route 1, Box 95, Pauls Valley, OK 73075. Telephone: 405.238.9624 Fax: 405.238.6330 Email: [email protected]

19) Returned Checks: All NSF checks shall be assessed an additional $50 handling fee.

20) Arenas: COMPETITION ARENA: 250’ X 120’ (36.5 meters by 76 meters), TRAINING ARENA: 250’ X 120’

(36.5 meters by 76 meters)

21) Footing: Each arena includes specially generated competition footing that is owned and maintained by the NRHA. The footing is 70% sand, 25% clay/loam and 5% bio materials.

22) Dogs: Dogs must be kept on a leash and in accordance with the City of Oklahoma City Ordinance.

23) Parking: Please park as directed. Parking options are outlined on the attached stall reservation form.

24) THE FEI CODE OF CONDUCT

FOR THE WELFARE OF THE HORSE

The Fédération Equestre Internationale (FEI) expects all those involved in international equestrian sport to adhere to the FEI’s Code of Conduct and to acknowledge and accept that at all times the welfare of the horse must be paramount and must never be subordinated to competitive or commercial influences.

1. At all stages during the preparation and training of competition horses, welfare must take precedence over all other demands. This includes good horse management, training methods, farriery and tack, and transportation. 2. Horses and competitors must be fit, competent and in good health before they are allowed to compete. This encompasses medication use, surgical procedures that threaten welfare or safety, pregnancy in mares and the misuse of aids. 3. Events must not prejudice horse welfare. This involves paying careful attention to the competition areas, ground surfaces, weather conditions, stabling, site safety and fitness of the horse for onward travel after the event. 4. Every effort must be made to ensure that horses receive proper attention after they have competed and that they are treated humanely when their competition careers are over. This covers proper veterinary care, competition injuries, euthanasia and retirement. 5. The FEI urges all involved with the sport to attain the highest levels of education in their areas of expertise.

A full copy of this Code can be obtained from the Fédération Equestre Internationale, Avenue de Rumine 37, CH-1005 Lausanne, Switzerland. Telephone: +41 21 310 47 47. The Code is also available on the FEI’s website: www.fei.org. 2011 USEF National Youth Reining Championships & USEF Competition Name: Smartpak N. A, Junior/Young Rider Championships USEF# 326616 Competition Division(s) and Rating(s): CRIY*

Mow the fields. Haul the hay. Paint the barn — and the

house. Re-order supplements and office supplies.

Make sure we’re covered on the road and in the

ring. Get ready for the big competition. Win! Ship the trophy equestrian

home without a scratch. Rent a car and drive to the coast.

Take a vacation. Relax! You don’t have to bet the farm to check

off this season’s most important tasks. For details on how you can save big

with USEF MemberPerks, visit www.usef.org or call one of our Customer

Care agents at 859.258.2472. 2011 Adequan/USEF National Reining Championship

USEF-CH Youth, CRI-Y July 1 - 2, 2011 BACK NO.

HORSE INFORMATION: (One Horse Per Form) NAME OF HORSE: FEI REG. NO. (CRI Entries) NAME OF OWNER: PASSPORT NO.* (CRI Entries) OWNER NF MEMBER NUMBER: USEF REC. NO.** FOALING COUNTRY FOAL YEAR COLOR: SEX: BREED

*HORSES ARE REQUIRED TO BE LIFE RECORDED FOR CRI ** PASSPORT REQUIRED FOR CRI-Y

NAME AND TAX ID # OF PERSON/COMPANY RECEIVING PRIZE MONEY: Name: Tax ID:

NAME OF RIDER: FEI REG NO. (CRI Entries) BIRTH: / / NATIONALITY: NF MEMBER NO.

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, 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 [insert name] 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. competition, sport, or the Federation. Those likenesses shall not be 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 rights. Read it carefully before signing. I AGREE in consideration for my participation in this competition to the following: 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 release the Federation and the Competition from all claims for money damages or otherwise for any Harm to me or my horse and or any Harm caused by me or my horse to others, even if the Harm 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 at the Competition. I have read the Federation Rules about protective equipment, including GR801 and EV113, 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 the parent or guardian of a junior exhibitor, I consent to the child’s participation and AGREE to assume all of the obligations of this Release on the child’s behalf. I AGREE that the “Federation” and “Competition” as used above includes all of their officials, officers, directors, employees, agents, personnel, volunteers and affiliated organizations. 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. I represent that I have the requisite training, coaching and abilities to safely compete in this competition.

BY SIGNING BELOW, I AGREE to be bound by all applicable Federation Rules and all terms and provisions of this entry blank. Page 1 of 2

Owner: (signature) (print) Fees: Qty.: Subtotal:

Entry Fee - USEF Yth & CRI-Y $50 ------= Owner Address:

Entry Fee - USEF Yth Only $30 ------=

City: State: Post code:

Entry Fee - CRI-Y Only $50 ------=

FEI & USEF Drug Fees (Req'd) $23 X 1 = $23 Rider: (signature) (print) Stall Fee (At least 1 Req'd) $250 X =

Int'l High Perf. Fee (Req'd) $35 X 1 = $35

Trainer: (signature) (print) Total:

Make checks payable to the NRHA. Nominated Entries due 6/27/10. See premium book for all details. Mail entries to: NRHA, Attn: USEF Entries, 3000 NW 10th St., Oklahoma City, OK 73107 or fax to 405-946-8425. *PLEASE ALSO FILL OUT A BIO SHEET AND TURN IN AT THE SAME TIME AS YOUR ENTRY FORM*

HORSE, OWNER & RIDER BIOGRAPHIES ARE REQUISITE FOR THE BENEFIT OF THE ATTENDING PUBLIC *Please write in legible print

RIDER BIO:

OWNER BIO:

HORSE BIO:

Page 2 of 2

FORM #: ______

STALL RESERVATION FORM

Name of Stall Agent: NRHA ID #: (Person Paying Fees) Address of Stall Agent:

C i t y : State: Zip:

Phone Number: ( ) Email:

PAYMENT MUST ACCOMPANY STALL RESERVATION FORM OR IT WILL NOT BE ACCEPTED. All information on stall reservation form must be completed. Stalls are assigned FIRST COME, FIRST RESERVED based on the order in which they are received by NRHA. Stall agents are responsible for the payment of ALL stalls on their reservation form. Stall agents must include all horses in their group on the stall reservation form to GUARANTEE placement as a group. If you wish to be stalled with your trainer or another exhibitor, those reservations must be listed on the stall agent’s (person reserving the stalls) reservation form. All stall reservations must be received no later than June 1, 2011 to be guaranteed placement. Reservations received after June 1, 2011 must be purchased at the show office upon arrival. Stall assignments may change without notification. Whether you are showing in the NRHA Derby, NRHA Derby Ancillary classes or bringing a non- showing horse-all horses must have a stall.

PLEASE BE SURE TO LIST EACH HORSE’S NAME ON THE BACK OF THIS PAGE TO ENSURE A STALL.

Please check the box(es) that apply to your stall order: Stall Fees:  Super Barn - Stall Sponsor: $175 Showing Horse Stall/ Tack Stall/ Youth Stall $225 Non-Showing Horse  Super Barn - Non Stall Sponsor: $275 Showing Horse Stall/ Tack Stall/ Youth Stall $325 Non-Showing Horse  All other barns (Sponsors and Non Sponsors): $175 Showing Horse Stall/ Tack Stall/ Youth Stall $225 Non-Showing Horse  Day Stall (only available to ancillary horses, up to 3 days): $50 ______

Stall Tally: Number of Stalls Cost of Stall Type Sub Total $175 $225 $275 $325 $50 Grand # of stalls: Grand Total = $

Stall Refunds: Stall fees will be refunded if written request from the stall agent is received by the NRHA

office on or before June 27th. A $30 handling fee will be charged per stall on request made after June

27th and before July 2nd. There will be NO stall refunds made for request received July 3rd or later.

FOR OFFICE USE ONLY: Date Rec’d:______Check Amount: ______Check #: ______Date Entered: ______

Please Mail Payment and Form to NRHA: Derby Stalls, 3000 N.W. 10th Street Oklahoma City, OK 73107 It is required that you list the name of the horse and NRHA competition license number for all showing horses. If an NRHA license number is not listed, it will be assumed that it is a non-showing horse and will be charged accordingly. For tack stalls write “Tack” in the boxes. HORSE’S NAME AND/OR TACK STALL NRHA LICENSE #:

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Special Requests: ______**Payment is deposited upon receipt and special request does not guarantee assignment to a requested stall area; every attempt will be made to honor y o u r request.**

Please Mail Payment and Form to NRHA: Derby Stalls, 3000 N.W. 10th Street Oklahoma City, OK 73107 2011 Usef Horse Application USHJA Registration United States Equestrian Federation Competing in non-breed restricted USEF Licensed Competitions with hunter, hunter breeding, jumper, and/or hunter seat classes (except those listed in GR901.9, items 1-9, including leadline; exhibitions; games and races; Horse Recording classes for 4-H members; walk trot and academy classes; Opportunity classes) must have a USHJA Registration Number. □ $30 (one-time fee) Lifetime Recording (Required for Passports) NOTE: In order to receive USEF points, a horse must be recorded with USEF and registered with USHJA. If your horse already has a Age discount requires proof of age (i.e. registration papers). USHJA Registration, you do not need to reapply. □ $35 Birth to December 31st of year foaled. — AMERICAN PERFORMANCE HORSE — □ $85 Horses one year of age (from January 1st to December 31st of the first year after foaling). In an effort to recognize American-bred horses, USEF and the PHR now offer the American Performance Horse (APH). It is open to all American-bred horses. Simply □ $160 Horses two years of age (from January 1st to December 31st of the submit a copy of your breed papers and a processing fee of $10. Your horse will appear second year after foaling). in the APH standings and will be eligible for APH year-end awards. Go to www.phr.com □ $200 Horses three years of age or older for more information. □ $10 American Performance Horse Annual Recording SILVER STIRRUP AWARDS □ $75 2011 Recording (expires on November 30, 2011). PHR & APH Registered horses only The Silver Stirrup Awards recognize the performance of PHR® & APH horses at If the horse/ is being renewed under a new ownership, various state, regional and national levels of competition. For more information you must submit a bill of sale (GR1105). about the Performance Horse Registry and the American Performance Horse call, (859) 225-2035. HORSE/PONY INFORMATION (PLEASE PRINT) □ $25 Silver Stirrup Annual Horse USEF#: ______□ $125 Silver Stirrup Life Name: ______OWNER’S INFORMATION* (REQUIRED) Previous Name(of horse): ______Previous Owner: Breed: ______Current Owner: ______Date of Birth: ______Height: ______Owner USEF#: ______Is this a new Address? □Yes □ No Sex : □ Stallion □ Mare □ Gelding Address: ______Color: □ Bay □ Chestnut □ Grey □ Black □ Roan □ Brown City: ______□ Sorrel □ Paint □ Pinto □ Dun □ Palomino □ Buckskin □ Cremello □ Albino □ White □ Appaloosa State: ______Zip: ______Markings: ______Phone: (______) ______E-mail: ______OWNER’S SIGNATURE (REQUIRED) Microchip:______Name of Breed Registry: ______Breed Registered Name: ______(signature certifies that you are the owner of the above animal. Breed Registered #: ______No agent’s signature accepted.) Sire: ______* Note: For USEF Recorded Horses that have multiple owners living in different states, Reg. #: ______please submit a letter signed by all owners declaring the zone in which you desire to Dam: ______have points tabulated. ** By submitting this application, I agree to abide by all USEF rules and verify that all information is Reg. #: ______correct. Dam’s Sire: ______*** For Horse Recording Requirements, please refer to the GR1102, GR1105, GR1107, GR1108 Reg. #: ______and GR1110 in the USEF Rule Book. It can also be found on the web at www.usef.org.

BREEDER’S INFORMATION payment (Fee must accompany application)

Breeder USEF#: ______Payment Total $ Name: ______Check / Money Order □Visa □MC □AMEX Credit Card Exp. Date: _____/ Address: ______City: ______Card Number State: ______Zip: ______zip code

NOTICE To obtain a Horse ID, please visit www.usef.org, log onto your Card Holder Name USEF account and create your horse's identification today. © 2009 by United States Equestrian Federation® All rights reserved. Reproduction without permission is strictly prohibited. UNITED STATES EQUESTRIAN FEDERATION : 4047 IRON WORKS PARKWAY : LEXINGTON, KY 40511 : (859) 258-2472 : FAX (859) 231-6662 : www.usef.org AWARDS PROGRAMS & NATIONAL CHAMPIONSHIPS AWARD CATEGORIES Recording your horse/pony automatically enters it in the Farnam®/Platform™ - USEF Horse of the Year Program provided the owner is an active Platinum, Senior, Junior, or Life member of the Federation. Horses must be recorded to compete at USEF National Championships. For qualifying information, please contact the Sport Programs Department at (859) 258-2472.

Adult Equitation** Hunter National Show Horse** Andalusian/Lusitano and Children’s Hunter Pony* Three Gaited Half-Andalusian/Lusitano Children’s Hunter Horse* Five Gaited Adult Amateur Hunter 18-35* English Pleasure – Open, Amateur, Junior Horse Adult Amateur Hunter Over 35* Hunter Pleasure – Open, Amateur, Junior Horse Green Working Hunter First Year Working Western – one award for Andalusian and Half- Green Working Hunter Second Year Country Pleasure Andalusian Amateur Owner Hunter 18-35 Driving Amateur Owner Hunter Over 35 Western Pleasure Specialty Regular Conformation Hunter Junior Exhibitor Green Conformation Hunter Paso Fino** Arabian and Half/Anglo-Arabian Small Junior Hunter 15/Under Top Ten High Point English Pleasure/Pleasure Driving – Open, Adult Small Junior Hunter 16-17 Years Roadster Amateur, and Junior Exhibitor Large Junior Hunter 15/Under Roadster Horse Under Saddle Country Pleasure/Country Pleasure Driving – Large Junior Hunter 16-17 Years Roadster Horse to Bike Open, Adult Amateur, and Junior Exhibitor Small Pony Hunter Roadster Pony*** – Open, Amateur, Hunter Pleasure – Open, Adult Amateur, Medium Pony Hunter and Junior Exhibitor and Junior Exhibitor Large Pony Hunter Saddlebred Western Pleasure – Open, Adult Amateur, Large Green Pony Hunter Three Gaited – Open, Amateur, and Junior Exhibitor and Junior Exhibitor Ladies Side Saddle Three Gaited Park Working Western Horse Small Green Pony Hunter Three Gaited Park Pleasure Specialty Horse Medium Green Pony Hunter Five-Gaited – Open, Amateur, and Junior Exhibitor Hunter/Jumper PreGreen Hunter* (Zones 1, 3, 4, 5, 6, 7, 8, 9, 10 only) Show Pleasure – Three-Gaited, Five-Gaited, Halter Amateur Owner 3'3" and Driving Dressage Horse – Open and Amateur High Performance Working Hunter Country Pleasure – English, Western, Hunter, Open: Training Level, First Level, Second Level, Third Level, Performance Working Hunter 3'6"–3'9" and Driving Fourth Level and FEI Combined Level Performance Working Hunter 3'3" Fine Harness – Open and Amateur Amateur: Training Level, First Level, Second Level, Third Pony Breeding* Welsh Level, Fourth Level and FEI Combined Level Pony Breeding Yearling Pleasure Pony, 12.2 hands and under Sport Horse – In hand, Under Saddle, and Show Hack Pony Breeding Two-Year-Olds Pleasure Pony, 12.2 hands - 13.2 hands CONNEMARA AND HALFBRED CONNEMARA** Pony Breeding Three-Year-Olds Pleasure Pony, not exceeding 14.2 hands Mare Hunter Breeding Pleasure Driving Stallion or Gelding Hunter Breeding Yearling Pony Hunter Hunter Hunter Breeding Two-Year-Olds Pleasure Pony, Adult to Ride Jumper Hunter Breeding Three-Year-Olds Pony Adult Hunter Specialty Jumper Western & Reining Driving (Combined)** Junior Jumper Reining – Open, Adult Amateur, Junior Exhibitor** Single Horse Low Junior Jumper Trail – Open, Adult Amateur, and Junior Exhibitor Pair Horses Amateur Owner Jumper Western Pleasure – Open, Adult Amateur, Four-In-Hand Horses Low Amateur Jumper and Junior Exhibitor Single Pony Open Jumper** Special Awards Pair Children’s Jumper* Grand Champion Andalusian/Lusitano Four-In-Hand Ponies Adult Amateur Jumper* Grand Champion Half Andalusian/Lusitano Driving (Pleasure)** Pony Jumper Grand Champion Arabian Single Horse 5-Year-Old Grand Champion Half/Anglo-Arabian Pair Horses 6-Year-Old Grand Champion Arabian Gelding Multiple Horses 7/8-Year-Old Grand Champion Junior Arabian Exhibitor Coaching Horses or Ponies Special Jumper* (Zone 9 Only) Grand Champion Junior Half-Arabian Exhibitor Single Pony Morgan Grand Champion Friesian Pair Ponies English Pleasure – Open, Amateur, Grand Champion Part-bred Friesian Multiple Ponies and Junior Exhibitor Grand Champion Green Pony Hunter Driven Dressage Western Pleasure – Open, Amateur, Grand Champion Junior Hunter 15 Years Friesian and Part-bred Friesian** and Junior Exhibitor and Younger In Hand Hunter Pleasure – Open, Amateur, Grand Champion Junior Hunter 16-17 Years Western Pleasure and Junior Exhibitor Grand Champion Amateur Owner Hunter Driving Pleasure Driving – Open, Amateur, Grand Champion Green Hunter Dressage and Junior Exhibitor Grand Champion Regular Hunter Specialty Classic Pleasure Saddle Grand Champion Conformation Hunter Hunter Classic Pleasure Driving Grand Champion Hunter Breeding Park Saddle Grand Champion Paso Fino Junior Exhibitor Park Harness Grand Champion Morgan Road Hack Grand Champion Amateur Saddlebred Horse Hackney Pony – Open and Amateur In-Hand Grand Champion Welsh Pony Hackney/Harness Pony – Open and Amateur Driving High Score Connemara Pony for Combined Training Pleasure Pony Driving Dressage – Training Level, First Level, High Score Connemara Pony Hunter Hackney Roadster*** – Open, Amateur, and and Second Level through Fourth Level “People’s Choice” Shetland Harness Pony Junior Exhibitor Versatility “People’s Choice” Shetland Roadster Pony

*Zone Only **National Only ***Shares Award with Hackney Roadster Pony Contact the USEF Sport Programs Department for Qualifying Information (859) 258-2472 UNITED STATES EQUESTRIAN FEDERATION : 4047 IRON WORKS PARKWAY : LEXINGTON, KY 40511 : (859) 258-2472 : FAX (859) 231-6662 : www.usef.org 2011 USEF MEMBERSHIP APPLICATION UNITED STATES EQUESTRIAN FEDERATION Please use a separate application for each member The United States Equestrian Federation (USEF) membership year begins on December 1. All memberships (except Life) expire on November 30. The effective date of membership is the date on which the application and correct dues are received by the USEF office (exceptions see GR203). To be eligible for USEF Awards including the USEF Horse of the Year Program, you must be a Senior Active, Junior Active, or Life Member. By submitting this application, you agree all information is correct and you agree to abide by all USEF rules. 1. PERSONAL INFORMATION 6. UNITED STATES EQUESTRIAN FEDERATION MEMBERSHIP Select only one membership type. Note: If you own a horse that competes at USEF Licensed TITLE: □ Mr. □ Mrs. □ Ms. □ Miss □ Other Competitions, you should select a USEF Competing Membership. NAME: COMPETING MEMBERSHIP Competing members are those individuals who are eligible to participate in USEF Licensed ADDRESS: Competitions as a rider, driver, handler, vaulter, longeur, owner, lessee, agent, coach, trainer, City, State, Zip: competition manager, or competition secretary. (Exceptions found in GR901.9) Competing membership benefits include automatic insurance, a subscription to equestrian magazine, Phone: and MemberPerks. Mobile: □ 3-YEAR ACTIVE (Junior or Senior — expires 11/30/2013) . . . . . $150 Fax: □ 1-YEAR JUNIOR ACTIVE (expires 11/30/2011) ...... $55 (Individuals who have not yet reached their 18th birthday on 12/01/2010) E-mail: □ 1-YEAR SENIOR ACTIVE (expires 11/30/2011) ...... $55 U.S. CITIZEN: □YES □NO IF NO, WHAT COUNTRY? □ LIFE MEMBER ...... $2,500 OTHER MEMBERSHIPS USEF MEMBER #: For members who do not participate in USEF Licensed Competitions as a rider, driver, □ Check here if this is a new address. vaulter, owner, lessee, trainer, coach, handler, longeur, agent, competition manager, or competition secretary. 2. DATE OF BIRTH (required for juniors and amateurs) □ USEF EQUESTRIAN (includes automatic insurance and MemberPerks) ...... $35 (mm/dd/yy): / / □ COLLEGIATE EQUESTRIAN (includes MemberPerks and 4 issues of equestrian) . . $25 3. Breed/discipline Affiliation (required) College/ University □ CLUB EQUESTRIAN (includes MemberPerks) ...... $15 Please designate a primary breed/discipline affiliation. This information will be used to determine proportional representation on the USEF Board of Directors (GR202.2). Please Non-Member Amateur Card (Complete section 4) ...... $30 designate the primary breed/discipline affiliation as (1). You may also select a secondary □ choice as (2). EXAMPLE: Hunter 1 Driving 2 7. UNITED STATES HUNTER JUMPER ASSOCIATION MEMBERSHIP Andalusian/Lusitano Arabian/Half-Arabian/Anglo-Arabian Connemara In order to compete as a rider, trainer, owner, or his/her agent(s) at non-breed restricted USEF Licensed Competitions in any Hunter, Hunter Breeding, Jumper or Hunter Seat Equitation Dressage Driving Endurance English Pleasure Eventing classes, a person must be an active member of the United States Hunter Jumper Association, Friesian Hackney Hunter Jumper Morgan Inc. Exceptions: Local competitions and the exceptions in GR202.1 and GR901.9. If you want to join WCHR, please visit www.ushja.org. National Show Horse ParaEquestrian Parade Paso Fino □ USHJA 3-YEAR ACTIVE (competing membership) expires 11/30/2013 . . . . $150 Reining Roadster Saddlebred Shetland Vaulting □ USHJA ACTIVE MEMBER (competing membership) ...... $55 Welsh Western □ USHJA LIFE MEMBER (competing membership) ...... $1,500 4. Required Signature □ USHJA ASSOCIATE (non-competing membership) ...... $35 Every member MUST sign and check the appropriate box below. Under 18 yrs, please check 8. EQUESTRIAN MAGAZINE the Junior box and and have parent/guardian sign below. If 18 yrs and older and you have USEF Competing Members with U.S. addresses receive a subscription to equestrian. not participated in any professional activities as cited in GR1306, you are considered an □ I prefer to view equestrian on the USEF website and do not need a mailed copy. amateur. Amateur status is also required for anyone who competes in amateur classes. My household receives duplicate copies of equestrian and I do not need a copy. PLEASE NOTE: Individuals who sign as a professional must complete the amateur □ reclassification process prior to being reinstated as an amateur. See GR1308 for details of □ Foreign addresses add international postage ...... $20 the process. 9. USEF RULE BOOK □ AMATEUR □ PROFESSIONAL □ JUNIOR You can view the entire USEF Rule Book on our website, www.usef.org. By signing below, you or parent/guardian are in agreement with USEF GR1306-GR1308, □ I do not need the Rule Book and can access it online. and Federation Release, Assumption of Risk, Waiver and Indemnification. (See reverse side) I would like to receive the 2011 USEF Rule Book in the following format: (Sign in ink) □ USB drive (if none received in 2009 or 2010) ...... $0 □ USB drive (if purchasing an additional one) ...... $20 5. Renewal □ Printed Version ...... $10 □ No, I do not wish to receive a paper renewal form in 2012. I will renew online. □ Binder ...... $10 10. Olympic/International Equestrian Team USA

Contribute to EQUESTRIAN TEAM USA Success (Your contribution is tax deductible to the extent permitted by law.) ____$25 ____$50 ____$75 ____$100 Other ______

Payment (Total of 6,7,8, 9 and 10) (Do not send cash) . . .$______Exp. Date: / / Billing Zip Code:______

□Check/ Money Order (Payable to USEF) □VISA □MasterCard □AMEX Card Holder Name (Print) Card Number: Card Holder Signature

© 2010 by United States Equestrian Federation® All rights reserved. Reproduction without permission is strictly prohibited. USEF : 4047 IRON WORKS PARKWAY : LEXINGTON, KY 40511 : PHONE (859) 258-2472 : FAX (859) 231-6662 : www.usef.org ©2010 USEF USEF GENERAL INFORMATION I AGREE that “the Federation” and “Competition” as used herein includes the Licensee and Competition Management, as well as all of their officials, officers, USEF annually pays a portion of your Life, Senior Active, Junior Active and USEF directors, employees, agents, personnel, volunteers and Federation affiliates. Equestrian dues to a third party insurance company for automatic insurance coverage. Annual dues for Senior and Junior members include $16 for a one-year I AGREE that I choose to participate voluntarily in the Competition with my horse, as non-deductible subscription to equestrian magazine. 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 By submitting this application, you agree all information is correct and you agree to sports and the Competition involve inherent dangerous risks of accident, loss, and abide by all USEF rules. serious bodily injury including broken bones, head injuries, trauma, pain, suffering, or death (“Harm”). USHJA GENERAL INFORMATION I AGREE to hold harmless and release the Federation and the Competition from A benefit of your USHJA Membership is a one-year subscription to In Stride all claims for money damages or otherwise for any Harm to me or my horse and magazine and $9 of your USHJA membership dues include this subscription. For for any Harm of any nature caused by me or my horse to others, even if the Harm USHJA Outreach, Affiliate, Collegiate and Farm memberships go to www.ushja.org. arises or results, directly or indirectly, from the negligence of the Federation or the From time to time, USHJA sends important information to their membership about Competition. association happenings and other promotional news from sponsors. By submitting I AGREE to expressly assume all risks of Harm to me or my horse, including Harm this application you agree to abide by all the USHJA rules and agree to uphold the resulting from the negligence of the Federation or the Competition. USHJA Ethics Statement. I AGREE to indemnify (that is, to pay any losses, damages, or costs incurred by) Member Perks the Federation and the Competition and to hold them harmless with respect to As a USEF member, you’ll reap the rewards all year long with the MemberPerks claims for Harm to me or my horse, and for claims made by others for any Harm Free Enrollment Program featuring a special collection of companies that support caused by me or my horse while at the Competition. I have read the Federation equestrian sport. See current MemberPerks list at www.usef.org. Rules about protective equipment, including GR801 and, if applicable, EV114, and I understand that I am entitled to wear protective equipment without penalty, and Privacy Information 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 USEF reserves the right to share member data (including but not limited to guardian of a junior exhibitor, I consent to the child’s participation and AGREE to all membership numbers, horse ID numbers, horse recording numbers) with those of the above provisions and AGREE to assume all of the obligations of this Release Breed and Discipline Affiliates that have entered into Data Sharing Agreements with on the child’s behalf. I represent that I have the requisite training, coaching and USEF for purposes of better serving their joint members. abilities to safely compete in this competition. United States Olympic Committee Requested Information I AGREE that if I am injured at any Competition, the medical personnel treating my The United States Olympic Committee is required to submit data to Congress and injuries may provide information on my injury and treatment to the Federation on the the President concerning the participation of women, individuals with disabilities official USEF accident/injury report form. and racial and ethnic minorities in the amateur athletic and administration BY SIGNING IN SECTION 4 ON PAGE ONE, I AGREE to be bound by all applicable activities of national governing bodies. As a result, we have included the following Federation Rules and all terms and provisions of this Federation Release, questions so that we may fulfill our required reporting to the United States Olympic Assumption of Risk, Waiver and Indemnification document. Committee. This data is for analysis only. Submission is voluntary. Failure to supply this information will not jeopardize or adversely affect your membership status with The USEF —Who we are USEF. The following categories are defined and named by the U.S. Government. Equestrian competitors, leisure riders, coaches, fans and enthusiasts each share Please check one: a personal bond with the horse. This commonality defines the membership of the United States Equestrian Federation [USEF] which serves as the National Governing Race/national origin: Body for Equestrian Sport. □ White (not of Hispanic origin) □ American Indian or Alaskan Native The USEF is dedicated to uniting the equestrian community, honoring achievement, □ Black (not of Hispanic origin) □ Native Hawaiian or Pacific Islander and serving as guardians of equestrian sport. Since its inception in 1917, the □ Hispanic or Latino □ Asian Federation has been dedicated to pursuing excellence and promoting growth, all while providing and maintaining a safe and level playing field for both its equine Other: I elect not to identify my racial origin or ethnicity. □ and human athletes. Disability Status: The USEF trains, selects, and funds our United States Equestrian Team which Are you an individual with a mental or physical disability? consistently wins medals at the highest level of international competition, including the Olympic Games. The USEF also licenses equestrian competitions of all levels □ Yes □ No across the United States each year. Gender: Fostering growth among newcomers as well as the coming generation is paramount □ Female □ Male to the Federation’s continued success. Our young equestrians continually raise the bar pushing themselves to be better and strive for excellence, all while fostering and FEDERATION RELEASE (required signature, see Section 4) strengthening the connection between themselves and their horses. Federation Release, Assumption of Risk, Waiver and Indemnification. The USEF contributes to the greater good of horses by assisting with their protection This document waives important legal rights. Read it carefully before and welfare in crisis situations and natural disasters, as well as in daily competition. signing. As part of this pledge to protect equine welfare, the USEF continues to be a resource I AGREE in consideration for my participation in any and all Federation licensed and/ for federal and state governments and works closely with other national equine or endorsed competitions (“Competition”) to the following: organizations.

© 2010 by United States Equestrian Federation® All rights reserved. Reproduction without permission is strictly prohibited. USEF : 4047 IRON WORKS PARKWAY : LEXINGTON, KY 40511 : PHONE (859) 258-2472 : FAX (859) 231-6662 : www.usef.org ©2010 USEF Return completed form to: 2011 FEI Horse Registration Form Fax: (859) 231-6662 or united states equestrian federation - all things equestrian Mail to: United States Equestrian Federation Attn: FEI Registration 4047 Iron Works Parkway, Lexington, KY 40511-8483

• Any results, points or qualifications will not count unless your EIF Registration is completed prior to starting an FEI competition. • FEI Registrations need to be renewed each year. • Please return this form no later than 4 weeks prior to the first day of competition, applications received less than 4 weeks prior to the show could be subject to a Rush Charge of $30. • USEF only registers U.S. owned horses.

horse information (Please print) horse Discipline Previous FEI Registration # Horse Recording # (Mandatory) FEI Passport # (If applicable) Is Passport approved? Horse Recording is (Check one) Life Annual Horse’s USEF Recorded Name (exactly as recorded with USEF) Sex (Check one) Stallion Mare Gelding Foal Date Color of horse Breeder Country of Birth Microchip # Breed Breed Registration # sire Dam Sire of Dam

Owner information (Please print) USEF Membership # (Mandatory) rider discipline owner Name nationality rider USEF Membership # (Mandatory) Last Name First Name N nationality

IMPORTANT Contact Information (Please print) name e-mail address physical address city state zip Phone Number ( ) Cell Phone ( )

total due. . . . . $15 .00

UNITED STATES EQUESTRIAN FEDERATION : 4047 IRON WORKS PARKWAY : LEXINGTON, KY 40511 : 859.258.2472 : FAX 859.231.6662 : WWW.USEF.ORG ______PAYMENT INFORMATION (Do not detach) ENTER AMOUNT FROM ABOVE TOTAL AMOUNT ENCLOSED $ □□□□□□□□.□□ PAYMENT METHOD (PLEASE DO NOT SEND CASH) Make Check Payable to: United States Equestrian Federation □ CHECK #______We also accept □ Visa □ AMEX or □ MasterCard Card Number: Exp. Date: □□□□□□□□□□□□□□□□ □□/□□□□ Card Holder’s Name (Print) ______Billing Zip Code Card Holder’s Signature______□□□□□ Return completed form to: 2011 FEI RIDER REGISTRATION FORM Fax: (859) 231-6662 or UNITED STATES EQUESTRIAN FEDERATION Mail to: United States Equestrian Federation Attn: FEI Registration 4047 Iron Works Parkway, Lexington, KY 40511-8483

• Any results, points or qualifications will not count unless your FEI Registration is completed prior to starting an FEI competition. • FEI Registrations need to be renewed each year. • Return this form no later than 4 weeks prior to the first day of competition. Applications received less than 4 weeks prior to the show could be subject to a Rush Charge of $30. • USEF only registers U.S. citizens.

RIDER INFORMATION (Please print)

USEF MEMBERSHIP # (Mandatory) PREVIOUS FEI REGISTRATION #

RIDER DISCIPLINE NATIONALITY

FIRST NAME LAST NAME

ADDRESS CITY

STATE ZIP

PHONE NUMBER ( ) CELL PHONE ( )

E-MAIL GENDER (Check one) MALE FEMALE

DATE OF BIRTH

EMERGENCY CONTACT INFORMATION (Please print)

NAME E-MAIL

PHYSICAL ADDRESS CITY

STATE ZIP

PHONE NUMBER ( ) CELL PHONE ( )

FEI RIDER REGISTRATION . . . . .$15 .00 Riders age 17 and under as of January 1, 2011, are FREE .

UNITED STATES EQUESTRIAN FEDERATION : 4047 IRON WORKS PARKWAY : LEXINGTON, KY 40511 : 859.258.2472 : FAX 859.231.6662 : WWW.USEF.ORG ______PAYMENT INFORMATION (Do not detach) ENTER AMOUNT FROM ABOVE TOTAL AMOUNT ENCLOSED $ □□□□□□□□.□□ PAYMENT METHOD (PLEASE DO NOT SEND CASH) Make Check Payable to: United States Equestrian Federation □ CHECK #______We also accept □ Visa □ AMEX or □ MasterCard Card Number: Exp. Date: □□□□□□□□□□□□□□□□ □□/□□□□ Card Holder’s Name (Print) ______Billing Zip Code Card Holder’s Signature______□□□□□ © 2011 by United States Equestrian Federation® All rights reserved . Reproduction without permission is strictly prohibited .