Aitkens Nominations Page – PCQ Metropolitan Zone 1

Name*

Club*

Non Zone 1 Clubs to choose Other and then enter their club name in the following field

Other Club Name*

Enter the name of your club here if not in Zone 1

This field is hidden when viewing the form

Pony Club

D.O.B*

Email*

Please enter Parents email if under 16

Contact Mobile Number*

Please enter Parents number if under 16

PCAQ Number*

PIC Number*

Class*

Senior Height Class*

Height must be 70cm or over too be eligible for overall awards.

Horse's Name*

Card Number*

Date and Event where Qualified*

Riders History, Goals and Results*

Phone

This field is for validation purposes and should be left unchanged.