ENTRY FORM PAIR PACE

Rider Name ______________________________________________________________________________________________

Horse Name _____________________________________________________________________________________________

Rider Address ___________________________________________________________________________________________

City _______________________________ State _________________________ Zip ___________________________________

Telephone __________________________________________ Cell ________________________________________________

Email __________________________________________________________________________________________________

EMERGENCY CONTACT NAME _________________________________________ TELEPHONE NUMBER ________________________________________________

$20.00 per round on the course if entered and paid for 2 DAYS prior to the event, $25.00 per round on the day of the show if not previously registered.

MEMBERSHIP $35.00 GOOD UNTIL JULY 14TH 2011. DEPOSIT FOR BIB $10.00

EMT FEE $10.00 MAKE CHECK OUT TO: ALEXANDRA ANWYL-DAVIES

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