USIHC Lifetime Achievement Medals
Name of Person Applying:
First Name
Last Name
Horse or Rider Applying for:
Horse(s) or Rider(s) from Qualifying Scores:
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please list the medals and categories applying for:
*
Would you like to order the previous medals also?
Yes
No
If your qualifying scores were at an international competition such as the World Championships and/or Youth Cup where you competed under the banner of the US, please provide the name of the competition(s) and the scores:
Submit
Should be Empty: