Provincial Champs GOLD ONLINE ENTRY

Manitoba Dressage Club Inc.

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PROVINCIAL CHAMPIONS GOLD ONLINE ENTRY

Autumn Classic Bronze & Gold Competitions + Manitoba Gold Provincial Championship
September 6th-8th 2024

ENTRY DEADLINE: No later than midnight Friday Aug 23th.
ONLY ONE HORSE PER ENTRY FORM

PLEASE COMPLETE ALL FIELDS! or entry will not be received.

* Indicates required field

Name of Rider *

First

Last

age of rider if under 18 *

Address *

City *

Province *

Email *

Phone Number *

Country *

EC Gold License # *

MHC # *

DW/MHT/MPC/Westman/WD MEMB # *

Name of Horse *

Horses Breed *

Horses Age *

Horses Sex *

Mare Gelding Stallion

Horses colour *

Horses height *

Horse Recording # (Previously Passport #) *

Name of Horses Owner *

Owners Phone # *

Owners Address *

City *

Province *

Country *

EC gold license # *

DW/MHT/MPC/Westman/WD MEMB # *

MHC # *

Person Responsible *

EC license # *

EC license type *

Gold Platinum

Category *

(note that AAs must have official AA status from Equine Canada. If competing with a temporary EC Sport license you may not enter as an AA)

Check off the Level/Division, Category and Test (s) to be ridden:

Qualifying score (Minimum 55% at level competing at, please note the show and judge where the qualifying score as received) *

Saturday

Sunday

Introductory

INTRO Sat ($100 both tests) *

Test B

INTRO SUN ($100 both tests) *

Test C

Training Level

Training Sat ($100 both tests) *

Test 2

Training Sun ($100 both test) *

Test 3

First Level

1st Sat ($100 both tests) *

Test 2

1st Sun ($100 both tests) *

Test 3

Second Level

2nd Sat ($100 both tests) *

Test 2

2nd Sun ($100 both test) *

Test 3

Third Level

3rd Sat ($100 both test) *

Test 2

3rd Sun ($100 both tests) *

Test 3

Fourth Level

4th Sat ($100 both tests) *

Test 2

4th Sun ($100 both tests) *

Test 3

Freestyles

FS Saturday Only ($55) *

First Second Third Fourth

FEI Division: *

FEI C/P/Jr/Yr Sat ($140 both tests) *

Team

FEI C/P/Jr/Yr Sun ($140 both tests) *

Individual

FEI Small Tour

FEI Small Tour Sat($140 both tests) *

Prix St Georges

FEI Small Tour Sun ($140 both tests) *

Intermedaite 1

FEI Medium Tour

FEI Medium Tour Sat ($140 both tests) *

Intermediate A

FEI Medium Tour Sun ($140 both tests) *

Intermediate B

FEI Big Tour

FEI GP Sat ($140 both tests) *

Grand Prix

FEI GP Sun ($140 both tests) *

Grand Prix Special

FEI Freestyle

FEI FS Saturday Only ($75) *

Pony Junior Young Rider I-1 Grand Prix

Stabling Fees (Mandatory) *

$85 weekend

Tack Stall (Recommended) *

$68 weekend

Unserviced Camping Fee ($10.50 per night) *

Shavings $11/bag *

Admin Fee (Mandatory)

Medic Fee (Mandatory)

$45.00

$30.00

Drug Test Fee (Mandatory)

DC Levy (Mandatory)

$8.00

$10.00

MHC Levy (Mandatory)

$5.00

Friday Warm up in show ring *

RING 1 - $35 for 30 minutes RING 3 - $20 for 15 minutes (show ring)

Warm up ring times
(Please choose between 1:00-7:00pm)

1st choice *

2nd choice *

3rd choice *

I'd like to share 30 minute warm-up in Ring 3 with: *

Stable or tack stall me with: *

Coach Information

Please List your Coach at the Competition and their EC Coaching Number or sign below if you are declaring you are Self Coached *

Name of Coach *

EC Coaching Number *

If you have a coach at the competition who is NOT EC Registered or Licensed you MUST pay the MHC Coaching Levy. If you do Not have a coach at the competition you are self coached and DO NOT pay the levy. *

5.00

As the person responsible I hereby certify that the horse listed on this entry form has met the requirements of Article A519, Vaccinations (See rules of Equestrian Canada Section A, General Regulations Article A 519 Vaccinations) By signing this document electronically I agree that I consent to utilize electronic signatures in lieu of paper documents. *

DATE: *

EC SPORT LICENSE # *

Any other notes to the show manager? *

PLEASE NOTE:
Payment, waiver form and negative Coggins test form part of this entry and must be sent to the show manager for your entry to be valid.
Please take a minute to add up your fees from the totals above, and note the amount in the boxes below.
If paying by PayPal Add 4% to this amount to cover credit card/merchant fees or do not pay 4% fee and pay by e transfer to [email protected]
NO CHEQUES ACCEPTED
Please fill in your totals in these fields before progressing and double check your addition:

Class Entry Totals *

Subtotal: *

Stabling Totals *

4% of Subtotal: *

Other Fees *

Total: *

NOTE YOUR TOTAL ON A SEPARATE PIECE OF PAPER - YOU WILL NEED TO ENTER YOUR TOTAL WHEN YOU GET TO THE PAYMENT PAGE. DO NOT USE YOUR BROWSER'S "BACK" BUTTON!!

Click Submit to proceed to the next step:

Submit

After you click "SUMBIT", please email the DW Show Manager to ensure your entry has been received!
[email protected]

Manitoba Dressage Club acknowledges that the work we do to support our dressage community takes place on Treaty 1 Territory
and the ancestral lands of the Anishinaabeg, Dakota, Cree, Oji-Cree, Dakota, and Dene Peoples, as well as on the homeland of the Red River Métis.
We respect the treaties made here and are grateful to live and play on this land.

manitoba dressage club inc.

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ALL RIGHTS RESERVED

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