2023 Muckleratz Entry Form

Form
Muckleratz Endurance Ride

July 1-2, 2023
Please fill out the below for all required fields marked with an *. You may enter both days with two different horses or one horse both days on this form. You will receive an email confirming your answers and if things change between now and the ride, you can use that email to edit your choices.

TEAM ENTRIES - Please sign up on separate entry form and link will be provided on the thank you page. There should be at least 3 team members and maximum 4 team members. Please have one of your team members be either a Young Rider, Junior or Adult rider with less than 1000 combined AERC miles (Greenbean). Lots of fun prizes, team mentoring, early parking, Friday clincs, team vetting, team photo. If you would like to be on a team, you do not have others to sign up with and you do not mind being assigned to a team, please answer the question on this entry form.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Are you an AERC Member Dec 1,2022-Nov 30,2023*
AERC Day Fee
AERC number (write NONE if you do not have an AERC#):*
ECTRA Number (write NONE if you do not have an ECTRA#):*
USEF Number (if riding USEF)- write NONE if you do not have a USEF#*
Select one rider weight category or Junior*
Emergency Contact Name & Tele #*
Date of Birth (if Junior)
Sponsor (if Junior)
Trailering with (put "self" if you are driving only your horses):*
# horses in trailer*
Size of rig (number of feet long) - Warning overflow for rigs >37'*

Riding Saturday (LD's & 50's)? Click "no" below if not riding or attending clinic on Sat.*
Saturday Distance:
Saturday entry fee
Saturday's Horse name:*
Saturday Horse Breed:*
Saturday Horse Color:*
Saturday Horse Age:*
Saturday Horse Sex:*
Saturday Horse AERC# (write none if no AERC#):*
Saturday Horse ECTRA#(write none if no ECTRA#):*
Saturday Horse USEF# (if riding USEF Lite on Saturday) - write none if no USEF #*
Saturday Horse Morgan or Arabian Horse Association registration#:
If you will be riding the 50-mile ride, please enter your AHA current membership number (no additional charge, prizes donated by PAHA):
Saturday Horse owner (write "self" or owner's name if it is not you):*
Will you be joining us for Friday night pizza? Please bring a salad or dessert.
Rider shirt size:

Would like to sign up for a Saturday team, but you do not have other team members and you do not mind being assigned to a team?*
If you answered YES above regarding a team, how many combined AERC miles do you have?

< 10001000-19992000-2999> 3000
Riding Sunday?*
Sunday Distance or INTRO events:
Sunday Entry Fee
Will you be riding the same horse as Saturday?
Sunday's Horse Name:*
Sunday Horse Breed:*
Sunday Horse Color:*
Sunday Horse Age:*
Sunday Horse Sex*
Sunday Horse AERC# (write none if no AERC#)*
Sunday Horse ECTRA#(write none if no ECTRA#):*
Sunday Horse owner (write "self" or owners name if it is not rider):*
The Saturday spaghetti dinner is included in the rider fee. Would you like to order extra meals @ $10 each?*
How many extra meals would you like on Sat ($10 each)?
Subtotal Meals
If you would like to join a raffle for USA Northeast Endurance, Inc, tickets will be $5 each. Proceeds will benefit the 2024 Northeast Team Endurance Championship at Fair Hill International June 21-24, 2024. Please indicate how many tickets you woul like below. Tickets will be available at the ride as well.
Subtotal Raffle Tickets
MUCKLERATZ ENDURANCE RIDE, JULY 2-3, 2022

LIABILITY, RELEASE AND AUTHORIZATION FORM

This release must be signed and returned with your ride entry. No cross-outs or additions are permitted.

As a participant in a ride sponsored by the American Endurance Ride Conference (AERC), I agree to abide by the rules of AERC, www.aerc.org and on Saturday USEF rules at www.usef.org.

In consideration for permission to enter and participate in the Muckleratz Endurance Ride, I do hereby for myself, my heirs and assigns, release and hold harmless ride management, ride personnel, AERC, ECTRA, PA DCNR, USA NE Endurance and Camp Muckleratz from all claims, demands, actions and causes of action of any kind, for injury or death sustained by me, my crew and my horse, and damage to my property, incurred during this ride. “Ride” includes from the time I and my horse arrive at base camp until the time that we leave the premises, as well as the actual event. “Horse” means the animal(s) I am riding.

I understand that horseback riding is an inherently dangerous activity and am aware that 1) the ride involves being in areas for extended periods of time far from communications, transportation, medical and veterinary assistance; 2) that these areas may have natural and man-made hazards, which ride management cannot anticipate, modify or eliminate; 3) that both my own horse and those of other contestants can be excitable, difficult to control and unpredictable, and can panic, bite, rear, kick, strike, stumble or fall; 4) that as a result of participating in the ride, I or my horse may be injured, die or my property damaged.

I agree to take full responsibility for myself and my horse and for any other party or animal that accompanies me; I recognize that the ride is a strenuous activity and I represent that I and my horse are in adequate physical and mental condition to participate. I recognize that my participation is voluntary. I consent to a random drug test to be performed on my horse.

I understand that if the horse I am riding is pulled for metabolic reasons and requires treatment on-site or an additional recheck by ride vet, this horse may not leave base camp until released by an authorized ride vet. Furthermore, I agree and authorize necessary and urgent treatment by a ride vet for a horse that I own, in the event this horse is ridden by another entrant and I am unable to provide explicit permission before or during the injury or illness event. I also agree I am responsible for all expenses incurred in such an injury or illness event.

I HAVE READ AND UNDERSTAND THE ABOVE LIABILITY RELEASE, AND AGREE TO BE BOUND BY ITS TERMS AND CONDITIONS:
Total

Name*

First NameLast Name
Legal guardian or parent if rider is a Junior:

First NameLast Name
Horse owner:*

First NameLast Name
Date

MonthDayYear
Date

When you hit submit, the thank you page will allow you to print your entry to pdf and you will receive an email confirmation with your data. If something changes between now and the ride, you can edit the form from the confirmation email you recieved, so please bookmark that email. Please make note of the total and submit payment electronically to USA Northeast Endurance, Inc. After you press submit you will receive a link to pay electronically (you do not have to pay the site fee, you can select zero -0-). Or mail a check to Christine Roberts, 214 Burke St, Plains, PA 18705 so that it will arrive before June 24, 2023.
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Muckleratz Endurance Ride