Entry Form

HUNTER PACE TO BENEFIT THE TIOUGHNIOGA RURITAN, DERUYTER ,NY
Pre Enter by July 26, 2009 or September 27, 2009 for a Discount
PLEASE CHECK PACE & DATE(S)
Saturday July 31, 2010: ____ Saturday October 9, 2010: ____
PRE ENTER FOR Both Paces BY 7/26/10 FOR A BIGGER DISCOUNT
The same team of riders must ride at
Both Hunter Pace dates to be eligible for
Championship Series Prizes.
Pre Entry Fees for the Series are
1. Masters Pace: 10 to 11 miles: $65 per rider___
2. Intermediate Pace: 5 to 6 miles: $65 per rider___
3. Field Hunters Pace: 15+ miles: $70 per rider___
Entry Fees for each Hunter Pace Date

Pre Entry Fees by 7/26 or 9/27

1. Masters Pace: $35 per rider___

2. Intermediate Pace: $35 per rider___

3. Field Hunters Pace: $40 per rider___

Teams of 1 or 2 riders:

1. Rider's Name: _______________________

Address: ____________________________

City, State, Zip: ______________________

Phone Number: ___________________

E-Mail: ________________________

Coggins/rabies:__________ (office use)

Number of riders:_________ (office use)

Team Number:___________ (office use)

Entry Fees the day of the Pace

1. Masters Pace: $40 per rider____

2. Intermediate Pace: $40 per rider____

3. Field Hunters Pace: $45 per rider___

Please Print Clearly

2. Rider's Name: ________________________

Address: ______________________________

City, State, & Zip: ________________________

Phone Number: _________________________

E-Mail:_______________________________

Coggins/ rabies:________ (office use)

1. Please bring your coggins and rabies with you the day of the pace.

2. You must sign a release form.

3. Teams may be composed of 1 or 2 riders.

4. Returned checks will be chared $30

5. No Refunds unless the Hunter Pace is canceled.

Make checks payable to: Tioughnioga Ruritan

Please mail with full payment for the entire team to:

Jill Higgins

7117 Richmond Hill Rd.

DeRuyter, NY 13052