MARSHALL & STERLING/USHJA

Marshall & Sterling Insurance/USHJA

National Championships
Application Form for Rated Hunter/Jumper/Equitation

Applications MUST be received by Midnight PST
Tuesday, September 12, 2023

Submissions after this will be treated as late entries, and follow the guidelines in the prize list.

Horse Information

Only ONE HORSE Per Entry Form.
Name Of Horse Or Pony*
Horse USEF#

Rider Information
Please list all riders for this horse below
#1 - Rider's Name
#1 - Rider's USEF Number*
#1 - Rider's USHJA Number
#2 - Rider's Name
#2 - Rider's USEF Number
#2 - Rider's USHJA Number
#3 - Rider's Name
#3 - Rider's USEF Number
#3 - Rider's USHJA Number

Trainer & Owner Information
Owner's First & Last Name
Owner's USEF Number*
Trainer's Name
Trainer's USEF Number*
Trainer's Email Address*
example@example.com

NATIONAL DERBY HUNTER

Based on Points - see prize list
Check box next to division to be entered

USHJA National Hunter Derby - OpenUSHJA National Hunter Derby - Jr/Am

JUMPERS

Accepted Based On Points - see prize list
Check box next to division to be entered

1.20M - USEF/USHJA Open Jumper1.0M - USEF/USHJA Low Child Jumpers1.30M - USEF/USHJA Open Jumpers1.0M - USEF/USHJA Low Adult AM JumpersUSEF/USHJA Low Junior JumpersUSEF/USHJA High Children's JumpersUSEF/USHJA Low Amateur JumpersUSEF/USHJA High Adult AM JumpersUSEF/USHJA Med Jr/Am Jumpers

EQUTATION

Age Group accepted based on points; Medals must be accepted in an age group to be eligible - see prize list
Check box next to division to be entered

USHJA Equitation (14 & Under)USHJA 3'3" Hunter Seat MedalUSHJA Equitation (15-17)EMO Insurance/USHJA 3'3" Jumping Seat MedalUSHJA Equitation (18 & O)USHJA 3'3" Adult Jumping Seat Medal

Payment Information
Contact Person*

First NameLast Name
Acceptance Letter Emailed To:*
example@example.com

USHJA ApplicationApplication Fees are non-refundable, unless for a duplicate entry from the same contact.

$100.00 Quantity
Item subtotal:$0.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty: