Entries will be accepted until the 125 rider limit is reached; at this point a waiting list will be kept. All forms will be acknowledged upon receipt. Pre-registration, payment in full is required. A $20 late fee will be charged if postmarked after June 7, 2003. |
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Rider's Name: |
Phone # |
AERC # |
Address: |
City: |
State: |
Zip: |
Horse's Name: |
AERC # |
Birth Date of Junior Rider: |
Sponsor's Name: |
Person to contact in case of emergency: |
Phone # |
Distance Entered: (check one) |
30 miles |
$65.00 |
30 miles Jr. |
$35.00 |
60 miles |
$65.00 |
60 miles Jr. |
$35.00 |
Division Entered: (check one) |
Heavyweight Middleweight Lightweight Featherweight Junior |
211 & up |
186-210 |
161-185 |
up to 160 |
Entry Fee (from above) |
Add $10.00 if not AERC member. |
Add $20.00 late fee if after June 7, 2003. |
Extra meals $5.00 each. |
Total (payment directions at bottom of page) |
RELEASE OF LEGAL LIABILITY As a participant in the Oconee WMA 30/60, I agree to abide by the rules of AERC, SERA, GERA and Oconee WMA. I understand that endurance riding involves being in remote areas for extended periods of time, far from communication, transportation and medical facilities; that these areas have many natural and man-made hazards which ride management cannot anticipate, identify, modify, or eliminate: that horses are excitable, difficult to control and unpredictable; and that accidents can happen to anyone at any time. I agree to take full responsibility for myself and the animal I am riding/handling. I will hold the ride management, all ride personnel, Department of Natural Resources, and all property owners over whose land the ride crosses blameless for any accident, injury, or loss that might occur due to my participating in the ride, and free from all liability for such injury or loss. |
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Rider Signature: |
Date: |
Parent/Guardian of Junior: |
Horse Owner if different from rider: |
PAYMENT METHOD: Credit Card Personal Check |
PAYMENT DIRECTIONS: Credit Card |
Personal Check - Payable to: Peggy Clark |
Address: 174 Spivey Rd. Eatonton, Ga. 31024 Phone # (706) 485-5117 |
E-mail Address: |
