MDA Show Entry Form

Maryland Dressage Assn Schooling Show Entry Form	2008 Membership Num.____
Only one horse per entry form. Exhibitor must include negative Coggins, Check payable to MDA, and self-addressed stamped envelope. Mail this form to the Show Secretary

Office Use Only

Date Rec'd

Coggins

W/C

Signature

Fees

Competition :	Date:
Name of Horse:

Name of Senior Rider:			Phone: ( )
Address:
City:	State:	Zip:	Email:

Name of Young Rider:			Phone: ( )
Address:
City:	State: Zip:	Email:	Birth Date:

Name of Owner:			Phone: ( )
Address:
City:	State:	Zip:	Email:

Class Number Class Name/Division Test Number Qualifier/Final

Indicate additional third ride. Payment due the day of show; do not include fee with this entry

Entry Fees: $16/ride members $20/ride non-members

Qual/Finals: additional $5 If entering Qualifier or Finals Class, add $5

Less work credit (Max $10) Maximum of 1 work credit per Horse/Rider team

Total Amount Due Include check payable to MDA, Inc.

Special Requests:______________________________________________________________________________________
_________________________________________________________________________________________________________________
Limit two rides per Horse/Rider team. An additional third ride may be accepted on a first come, first serve basis, if time permits, for a $16.00 entry fee, payable on the show day. Please indicate the third ride request under the Class section. Qualifying and Finals classes are excluded as a third ride request. Competitors will be notified of entry status by the Show Secretary, prior to the show. Copy of negative Coggins Test are required. No refund after the closing date unless replacement ride is found from the waiting list, or Doctor's Note or Vet Certificate dated within 7 days of show date is received. Work Credit form must be attached to receive entry fee discount.
Rider or Parent/Guardian Signature if under 21________________________________________
I/we recognize that there is an inherent risk of danger, serious injury, or death related to participating in activities involving horses and competing in horse shows. In consideration of MDA, Inc, accepting our application to participate in this show, we hereby agree to assume all risks associated therewith and do hereby release and agree to indemnify and hold harmless MDA, Inc, its agents, servants, and employees for all causes of action, including negligent acts or omissions, which may accrue as a result of any damage or injury that shall occur to any rider, horse, spectator, visitor, property, or equipment.