Circle D Horsemen's Association
CGA District 4
Show Date
Current CGA Membership is required for entry. What is your CGA Number?
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If you are not a member, type "New" in the box above
Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Email
*
example@example.com
Mount Name
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Division?
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Please Select
AAA+
AAA
AA
A
FC 12/Under
FC 13/Over
Open Pony
Lead Line
Date of Birth (Required if under 18)
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Month
-
Day
Year
Date
Event Selection:
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Birangle
Figure 8 Flags
Keyhole
Poles I
Quadrangle
Figure 8 Stake
Speed Barrels*
How do you want to enter?
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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?
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Yes, add $5.50 to entry cost
No Thank you
Financial Summary:
Calculate cost below
Event Cost:
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# of events x per event cost
There is a $10 ground fee for each horse/rider combo
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Add $10 to entry for rider fee (required)
Do you need to pay for CGA Membership?
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Yes, Add $30 for Individual membership
Yes, Add $60 for a Family Membership
No, my membership is current and active
Do you need to add anything additional? Additional Forms will be required.
Circle D Annual Membership, Individual $15
Circle D Annual Membership, Family $25
Circle D Year End Awards ($25 per horse/rider combo)
CGA Year End Award Membership (varies per award type)
Enter Total Entry amount:
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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
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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 causedby 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 competitorwill 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, orin his/her care, custody or control, and shall indemnify and hold harmless the California Gymkhana Association, Inc., it's officials and directors individuallyand collectively, and co-sponsoring organization(s), clubs, and arena owners, if any, from and against all charges and expenses of every kind and naturewhatsoever 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 acertain element of danger involved, and that you will be riding at your own risk. CALIFORNIA GYMKHANA ASSOCIATION, INC., DOES NOTPROVIDE MEDICAL INSURANCE FOR IT’S MEMBERS. In addition, I certify that I‘m either an Individual or Family Member of the CaliforniaGymkhana 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
Date
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Month
-
Day
Year
Date
How are you going to pay
*
Please Select
Venmo
Cash or Check at show (check payable to: Circle D
Submit
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