EVENTING APPLICATION

USEA Member #: (USEA membership required at time scores are achieved) Name of Rider Applying for Medal:

RIDER CONTACT INFORMATION Email Address: Address: City: State: Zip:

HORSE CERTIFICATE (complete if you would like a separate certificate for the horse) Name of Horse for Medal Award:

USEA Horse #: (USEA registration required at time scores are achieved)

OWNER INFORMATION (if different from the rider) Name: Address: City: State: Zip:

PLEASE MARK THE APPROPRIATE MEDAL YOU ARE APPLYING FOR: Level: ❑ Beginner Novice ❑ Novice ❑ Training ❑ Modified ❑ Preliminary Medal: ❑ ❑ ❑

SCORE SUBMISSION Dressage XC Jump Final Competition Name Date Venue Score Penalties* Score**

*XC Jump Penalties must be 0 for score to be considered. **Must have completed all three phases.

Mail or fax to: USEA Competitions Department, 525 Old Waterford Rd NW, Leesburg, VA 20176. Fax (703) 779-­0550

Requirements on next page MEDAL PROGRAM REQUIREMENTS

GENERAL REQUIREMENTS • Beginning with results from February 1, 2009 and onward. • An individual must have a current USEA Membership at the time scores are achieved. This includes the Beginner Novice level. • A horse must be registered as required at the level at which it is competing. Horses competing at Beginner Novice must have at least a USEA Limited Horse Registration at the time scores are achieved. • Venue is defined by location of the event, not the competition. For example, to earn a medal that requires scores be obtained at three separate venues, an individual could not submit scores from three competitions all located at the Kentucky Horse Park.

BEGINNER NOVICE : Must finish on a score of 50 or less three times ‐ scores must be obtained at two different venues : Must finish on a score of 45 or less three times – scores must be obtained at three different venues : Must finish on a score of 35 or less three times – scores must be obtained at three different venues

NOVICE Bronze Medal: Must finish on a score of 45 or less three times ‐ scores must be obtained at two different venues Silver Medal: Must finish on a score of 40 or less three times – scores must be obtained at three different venues Gold Medal: Must finish on a score of 35 or less three times – scores must be obtained at three different venues

TRAINING Bronze Medal: Must finish on a score of 50 or less three times – scores must be obtained at three different venues Silver Medal: Must finish on a score of 45 or less three times – scores must be obtained at three different venues Gold Medal: Must finish on a score of 35 or less three times – scores must be obtained at three different venues

MODIFIED Bronze Medal: Must finish on a score of 55 or less three times – scores must be obtained at three different venues Silver Medal: Must finish on a score of 45 or less three times – scores must be obtained at three different venues Gold Medal: Must finish on a score of 40 or less three times – scores must be obtained at three different venues

PRELIMINARY Bronze Medal: Must finish on a score of 55 or less three times – scores must be obtained at three different venues Silver Medal: Must finish on a score of 45 or less three times – scores must be obtained at three different venues Gold Medal: Must finish on a score of 40 or less three times – scores must be obtained at three different venues