Regional C2 Certification Application

Mount Information
Age*
Breed*
Gender*
Level of Training*
Strengths & Weaknesses*
Current Competition Level*
Please upload a current negative Coggins*

Cancelof
Please upload proof of vaccination for Influenza and Rhinopneumonitis (EHV-1/4)*

Cancelof
If this horse was not available for the testing would you have a replacement?*

YesNo

Declarations

I understand that my deposit is non-refundable and will be applied to the facility fee. Additionally, I understand that my District Commissioner/Center Administrator will be contacted to verify that I am a member in good standing and supports me in my pursuit of the certification.
Candidate Signature*

Clear
Date*

MonthDayYear
Date
Parent/Guardian Signature (if a minor; if not a minor sign your name again)*

Clear
Date*

MonthDayYear
Date

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Test(s) Desired