Entry Form

HUNTER PACE TO BENEFIT THE TIOUGHNIOGA RURITAN

Entry Form

HUNTER PACE TO BENEFIT THE TIOUGHNIOGA RURITAN, DERUYTER ,NY
PLEASE CHECK PACE & DATE(S)
Saturday August 6, 2011: ____ Saturday October 8, 2011: ____
The same team of riders must ride at
Both Hunter Pace dates to be eligible for
Championship Series Prizes.
___________________________________________
Entry Fees for each Hunter Pace Date

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

3375 Hughes Rd

Morrisville, NY 13408