Dressage & Combined Training Nomination Page

Name*
D.O.B.*
Date Format: DD slash MM slash YYYY
Contact Number*
This should be Parents Number for riders 15 years and under.
Email*

This should be Parents' email for 15 years and under
PCAQ Number*
If you do not yet have a PCAQ Number, enter TBA, but you will be required to show your membership card on the day.
PIC Number*
If you are unsure of your PIC number, ,enter TBA, but it will be required on your Horse Health Declaration to be handed in on the day of the event.
Club*
Other Club Name*
Enter the name of your club here if not in Zone 1
Nominating for:*
First Aid Levy - Both Events
Price: $ 10.00
First Aid Levy - Single Event
Price: $ 5.00
Dressage
Dressage Class*
Seniors Choose from Class 3, 4 or 5 and tick Seniors Box below.
Status
- Senior
Dressage Horse*
Dressage Card No*
If you are still awaiting your card enter pending. It i s your responsibility to supply this number before the start of competition.
Combined Training
Combined Training Class*
Seniors Choose from
Senior Height Class
Horse*
CT Card No*
If you are still awaiting your card enter pending. It is your responsibility to inform the organizers of your Card No before the start of the event
Club Secretary Details
Pmt
- Paid
Secretary Name*
Secretary Mobile*
Enter mobile Number for your Club Secretary
Secretary Email*
Payment
Total
$ 0.00
Credit Card

MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Phone
This field is for validation purposes and should be left unchanged.

Dressage