Shamrock Entry Form

Shamrock I____ Shamrock II____ Shamrock III____

Rider’s Name________________________________________AERC #_____________

Email:_________________________________________________________________

Emergency Contact-Phone________________________________________________

Division: please circle: Weight includes tack

Jr. [under 16 as of Jan 1] FWT [160] LWT [160-186] MWT [186-210] HWT [ 211+]

Horse Name:_______________________________________________ Age: ________

Horse’s AERC #:_____________ Horse Owner /AERC # _________________________

RIDE FEES: [INCLUDES DINNER FOR RIDER]

______$70.00 X _____ 30 mile event

______$80.00 X _____ 55 mile event

______$10.00 X _____ Extra dinner-per person

______$15.00 X _____ NON-AERC member fee (per day)

______$10.00 X _____ Corrals-Per Day (by reservation)

______$20.00 X _____ Pastures-Per Day (by reservation)

______ $5.00 X _____ AHA Entry Fee

______Total Ride Fee

Checks payable to: Susan Schomburg

RELEASE FORM

I, the undersigned, do hereby state that I have read and understand the following:

Riding can be a dangerous activity, horses are unpredictable animals, and endurance riding involves being in remote areas for long periods of time in these areas there are natural and manmade hazards which ride management can neither anticipate, modify or eliminate.

I therefore assume full responsibility for myself and the animal I am riding. I will hold the ride management, ride personnel, and all property owners whose land the ride crosses blameless for any accident, injury, or loss that might occur due to my participation in the ride and free from any liability for such injury or loss.

______________________________________

Signature: Date:________________________

Signature of Responsible Party if minor

is under 18 years of age

_______________________________________ Date:_______________________