Albany Agricultural Show    
Dressage Competition    
Sunday, 14 November 2021    
Entry Form    
Entries Close:  5th November 2021    
Competitor/Participant/ Restricted 
Rider Details      
Rider Name    
Mobile Phone    
Rider EA Number  
Young Rider
Rider Age Category:
Horse/Pony Details      
Horse Name    
Horse EA Number  
Horse Bridle Number  
Owner (if not Rider)    
Helper Duties    
Helper Name    
First Preference
Second Preference
Classes: To enter please indicate  'X' alongside the particular test    
EA Preliminary 1B    
EA Preliminary 1C    
EA Novice 2B    
EA Novice 2C    
EA Elementary 3B    
EA Elementary 3C    
EA Medium 4B    
EA Medium 4C    
EA Advanced 5B    
EA Advanced 5C    
FEI Para V Team    
FEI Para V Individual    
Total Tests    
Tests: Number of Tests  
Entry Fees ($28/test)    
Ground Fees ($10/horse)    
Day Membership Fee    
Late Entry Fee    
Total Fees:    
Your Entry will not be accepted without payment of the above fee
Direct Transfer
Account Name Southern Districts Dressage Club
BSB 036-168
Account Number 15-8842
Payment Receipt Details      
Receipt Number    
Dangerous Activity Acknowledgement      
Horse Sports are a Dangerous Activity    
I understand and acknowledge that horse sports are a dangerous activity and     
that horses can act in a sudden and unpredictable way, especially if
 frightened or hurt.
I understand and acknowledge that serious INJURY or DEATH may result from 
horse  sport  activities and in particular from events in which I participate.
I agree that I PARTICIPATE at my OWN RISK.    
Effect of this Document    
I understand that submission of this Entry Form constitutes    
 a complete and  unconditional release of the Equestrian Federation of      
Australia Ltd including all of its state bodies, coaches, Albany Agricultural 
Society  and Southern Districts Dressage Club,
 to the greatest extent allowed by law  in the event of me and/or     
the children under my care, suffering injury or death.    
I understand the Albany Agricultural Society and Southern Districts Dressage Club accepts no liability for the loss of,
or damage to, vehicles, or any other goods or articles, and does not offer any personal insurance to riders.
By submitting this Entry Form,  I ACCEPT I confirm having     
read and understood the  contents of this disclaimer.