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Home
About
Membership
Eventing
Events
Entry Stats
Times
Event Photographer
Results
Calendar
Year End Awards
Volunteer
News
Forms & Docs
Contact
Liz Fitzgerald Clinic Registration
Rider Info
Membership
(Required)
None
BREA
Rider Name
(Required)
First
Last
Address
(Required)
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
No
Owner Name
Entry
Entry Fees Non-Member
Price:
Non-Member Option
(Required)
Private Jump Lesson
Group Jump Lesson (of no more than 4 participants)
Private Flat Lesson
Group Flat Lesson
Entry Fees Member
Price:
Member Option
(Required)
Private Jump Lesson
Group Jump Lesson (of no more than 4 participants)
Private Flat Lesson
Group Flat Lesson
Jumping Level
(Required)
Tadpole
Cross Rails
Green
Advanced Green
Beg Novice
Novice
Training
Flat Only
Riding Level
What heights are you jumping? What are you wanting to work on? Please explain below, including flatwork.
Stabling
Limited day use stalls available, shavings provided. MUST strip stalls afterwards
Stall
Quantity
Price:
$40.00
Quantity
Coggins
Coggins Date
(Required)
MM slash DD slash YYYY
Coggins Accession #
(Required)
If a coggins is not submitted electronically, you must bring a hard copy of the coggins to the show for the secretary to keep.
Coggins Upload
(Required)
Accepted file types: jpg, gif, png, pdf, Max. file size: 64 MB.
Waivers
Waivers can be found here:
USEA Waiver
VT Waiver
BREA Waiver (print and email back)
BREA Waiver (complete & submit online)
For print waivers, click the link and print, then scan and attach below.
BREA Waiver Upload
Accepted file types: jpg, gif, png, pdf, Max. file size: 64 MB.
VT Waiver Upload
Accepted file types: jpg, gif, png, pdf, Max. file size: 64 MB.
USEF Release Upload
Accepted file types: jpg, gif, png, pdf, Max. file size: 64 MB.
Proof of vaccines must be sent to clinic organizer no later than May 13th (closing day).
Proof of Vaccinations
Proof of EWE/Tetanus/WNV/Rabies within one year required
Drop files here or
Select files
Accepted file types: jpg, gif, png, pdf, Max. file size: 64 MB.
Proof of Vaccinations
Proof of Influenza and Rhinopneumonitis within 6 months required
Drop files here or
Select files
Accepted file types: jpg, gif, png, pdf, Max. file size: 64 MB.
Total
Accepted Payments:
Check, made out to “BREA”
Mail to (must be post dated May 13th): Liz Fitzgerald Clinic Entry, ATTN: Casey Moyer 3199 Bradshaw Road, Elliston, VA 24087
Cash/check day of clinic
Notes to Organizer