Circle D Type 1 Show

Circle D Horsemen's Association

CGA District 4
Show Date
Current CGA Membership is required for entry. What is your CGA Number? *
If you are not a member, type "New" in the box above
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Mount Name*
Division?*
Date of birth (Required if under 18)

MonthDayYear
Date
Event Selection:*

BarrelsHurry ScurryPoles IISpeed BallSpeed BarrelsBig TSingle Stake
How do you want to enter?*

Regular ($5.50 per event - compete for buy back coupons and hi-point awards)Points (5.00 per event - compete for hi-point award only))Time Only ($4.50 per event -no awards, times to state only)
Do you want enter the mystery jackpot?*

Yes, add $5.50 to entry costNo Thank you
Financial Summary:

Calculate cost below
Event Cost:*
# of events x per event cost
There is a $10 ground fee for each horse/rider combo*

Add $10 to entry for rider fee (required)
Do you need to pay for CGA Membership?*

Yes, Add $30 for IndividualYes, Add $60 for FamilyNo, my membership is current and active
Do you need to add anything additional? Additional Forms will be required.

CGA Year End Award Membership (varies per award type)Circle D Annual Membership Family - $25Circle D Annual Membership Individual - $15Circle D Year End Awards ($25 per horse/rider combo)
Enter Total Entry amount:*
Are you paying with coupons? Enter credit amount here:
Make sure to bring all coupons to the show along with payment
Total Amount Due Circle D*
Bring cash or check to show - payment must be received 15 minutes prior to show start in order to participate
Release of Liability
The California Gymkhana Association, Inc., and co-sponsoring organization(s), if any, will not be responsible for any accident that may occur to be caused
by any horse competing at the show, or, for any article of any kind or nature 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 any horse owned, or
in his/her care, custody or control, and shall indemnify and hold harmless the California Gymkhana Association, Inc., it's officials and directors individually
and collectively, and co-sponsoring organization(s), clubs, and arena owners, 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. In signing this release, please bear in mind that gymkhana is a contest of speed, that there is a
certain element of danger involved, and that you will be riding at your own risk. CALIFORNIA GYMKHANA ASSOCIATION, INC., DOES NOT
PROVIDE MEDICAL INSURANCE FOR IT’S MEMBERS. In addition, I certify that I‘m either an Individual or Family Member of the California
Gymkhana Association.
By signing below, you acknowledge that you understand and support Circle D Horsemen’s Assoc., Inc. club and show rules and acknowledge the release of liablity.
Signature

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Date

MonthDayYear
Date
How are you paying?
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Circle D Horsemen's Association

Financial Summary: