EmailMe Form - losvaq

CGA State ID#
CGA Membership is required to ride. *
Yes
No
You must provide your CGA id card the first time you ride with District 35 or you will be required to pay CGA membership dues.
Rider Name *
First Last
Horse/Pony Name *
Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region
Email
Date of Birth (17 & Under)
Division: *
< Leadline
< A
< FC 13 & Under
< AA
< FC 14 & Over
< AAA
< AAA+
Select your division.
Events Set #1 Dates: 9/21, 11/23, 1/18, 3/15, 5/17. Please verify which events are being run at the show you are signing up for by going to www.losvaqueros.net Show Calendar link.
Speed Barrels
Figure 8 Flags
Barrels
Big T
Poles I
Birangle
Keyhole
If you are requesting setups they must be marked, this form completed, and must be called in to Show Secretary or President, and submitted 48 hours in advance.
Events Set #2 Dates: 10/26, 12/14, 2/22, 4/12, 6/7 Please verify which events are being run at the show you are signing up for by going to www.losvaqueros.net Show Calendar link.
Quadrangle
Figure 8 Stake
Poles II
Single Stake
Barrels
Speed Ball
Hurry Scurry
If you are requesting setups they must be marked, this form completed, and must be called in to Show Secretary or President, and submitted 48 hours in advance.
Show Fees: Click all that apply *
All 7 Regular Events $35.00 total
Individual Regular Events x __ $5.00 each
Setups x __ $5.00 each
Schooling Runs x __ $3.00 each
Los Vaqueros Family Membership $35.00
Los Vaqueros Individual Membership $30.000
CGA Membership Family $60.00
CGA Membership Individual $30.00
CGA Membership Upgrade $30.00
Additional Mount fee for Local Awards $20.00
Mystery Jackpot $5.00
Los Vaqueros and/or CGA Membership form must accompany the entry if paying membership(s) with your entry. Forms may be found at www.losvaqueros.net
Arena Fee *
$5.00 (mandatory)
CGA Awards Please Select if you wish to pay with your entry.
Please go to www.calgymkhana.com and print off forms to bring with you to the show if you are paying for CGA awards with your entry.
Amount due from above selections: *
$ Dollars . Cents
Don't forget the Arena fee is a $5.00 mandatory fee to ride with us and must be included in your total. Thank you!
Credit Due:
$ Dollars . Cents
If you have a 'Free Show' coupon or other credit enter it here.
Total Due to Pay at Show: *
$ Dollars . Cents
Please make sure you correctly add in everything you chose to do from above, including the arena fee!
Release of Liability:
You must sign a release of liability at the show before you can ride.
In addition, I certify that I am either a family or individual member of California Gymkhana Association.
The California Gymkhana Association, INC and co-sponsoring organization, if any, will not be held responsible for any accident that may occur or be caused by any horse competing at the show, or for any article of any kind that may be lost or destroyed or in any way damaged. Each competitor will be responsible for any injury that may be occasioned to any person or animal or damage to any property while on the grounds by a horse owned, or in his or her custody, or control, and shall indemnify and hold harmless the California Gymkhana Association, its officials and directors individually and collectively, and co-sponsoring organizations, clubs and arena owner, if any, from and against all charges and expenses of every kind and nature whatsoever arising out of or which may be incurred by reason of any accident, injury or damage to person or property caused by the ownership, competition or custody or control of any animal competition. Presentation of first signed entry form and/or membership application shall be deemed acceptance of this release throughout the entire show season for any subsequent California Gymkhana Association, Inc sanctioned function in which you or your child/children may participate. In signing this release, please bear in mind that Gymkhana is a contest in speed, that there is a certain element of danger involved, and that you will be riding at your own risk. We suggest you wear a helmet for safety. All members under the age of 18 MUST WEAR A HELMET AT ALL TIMES WHEN ON A HORSE!!
*
I certify the above Release of Liability Statement and acknowledge this form must be submitted before NOON Friday.
Please pay and sign when you arrive at the show. Thank you!
Sign Here at Show:
Please leave above box blank and sign at the show.
Show Secretary Signature:
Show Secretary Sign Above

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