Karen Fulcher/Mindset Equestrian Clinic Entry Form - Blue Ridge Eventing Association

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Southwest Virginia

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Karen Fulcher/Mindset Equestrian Clinic

Rider Info

Rider Name(Required)

First Last

Address

Street Address Address Line 2 City State Zip Code

Phone(Required)

Email(Required)

Horse Info

Horse Name(Required)

Horse Gender(Required)

Stallion

Mare

Gelding

Owner Same as Rider?

Yes

Owner Name

Entry

Pricing:

Junior Members: $85
BREA Members: $95
Non-Members: $105

Entry Fees

Lesson Participant

Junior Member

BREA Member

Non-Member

Lesson Type

Over Fences

Western Dressage

Dressage Confidence Building

In-Hand Work

Coggins Date(Required)

MM slash DD slash YYYY

Coggins Accession #(Required)

Coggins Upload(Required)

Accepted file types: jpg, gif, png, pdf, Max. file size: 2 GB.

BREA Waiver Upload(Required)

Download BREA Waiver

Accepted file types: jpg, gif, png, pdf, Max. file size: 2 GB.

USEF Waivers must be uploaded to participate!

USEF Release (complete online)

Complete USEF Release

Put in participant email at the bottom of the online form so that it sends a copy of the form to you TO UPLOAD HERE.

Accepted file types: jpg, gif, png, pdf, Max. file size: 2 GB.

Office Fee

Price:

Total

Payment Type

Check

Online

Mail checks to: Casey Moyer 3199 Bradshaw Road Elliston, VA 24087

Payment Method

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number Expiration Date Security Code Cardholder Name

Notes to Secretary

Quick Links

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Southwest Virginia

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