Area VI Year End Awards Registration Form

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Area VI 2006 Year-End Awards Registration Form Must be submitted by November 1, 2006 Please complete a separate form for each horse/rider combination Rider Name: Birthdate: (00/00/0000) Address:   Telephone: E-mail Address: Horse Name: Gender: G M S USEA# (required) USAE # Please check all levels at which this horse/rider combination might compete this year Beg Novice Novice Training Preliminary Intermediate Advanced A. DIVISIONAL AWARDS: These awards are automatically awarded and require no sign up. If you are eligible for ANY of these awards, you do not need to fill out this form. Beginner Novice Horse- Junior Novice Horse- Junior Training Horse- Junior Beginner Novice Horse- Senior Novice Horse- Senior Training Horse- Senior Preliminary Horse Intermediate Horse Advanced Horse Young Riders Preliminary Rider* Young Riders Intermediate Rider* Young Riders Advanced Rider* Area VI Horse/Rider of the Year (Horse/Rider combination with the most Area VI points) Area VI Rider of the Year (Rider with the most Area VI points) *To be eligible, membership in Area VI Young Rider Program is required* B. SPECIAL AWARDS Please select one Junior Novice Rider, 12 & under Adult Amateur Preliminary Rider Adult Amateur Training Rider Adult Amateur Novice Rider High Point USPC member - I hereby certify that I am an active member in good standing of Pony Club, USPC Inc, for the year 2006. C. BREED AND PONY AWARDS Please select one High score Pony High Score Appaloosa Reg. # High Score Morgan Reg.# High score Irish Sport Horse (submit copy of Registration Papers or copy of Irish Passport) Note: horse may not have competed above the CCI** Level. High score Mare I do hereby certify that my horse and I are eligible and therefore register to be considered for an Area VI Year-End Award as checked above. By checking this box I certify that all of the information above is correct. If any information is found to be false, I will forfeit my eligibility for any award. **If you did not select any of the awards listed in section B or C, do not click submit. You do not need to register for awards from the A section.** Send passport copies, registration copies, etc. (if required) to: USEA AREA VI AWARDS, c/o Robyn Whitlock, 909 Kelley Court Lafayette, CA 94549 Fax: (925)287-9090, e-mail: mrwhitlock@aol.com areavi@gmail.com (1/26/06)