Buyback Registration Application

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Please review the buyback registration Rules and Regulations prior to submitting application. Complete the application with as much information as you have available. If additional information is needed the registrar will contact you. Leaving blank or writing "unknown/NA" is acceptable. The required fields are marked with a *

Please remember, buyback registration does NOT mean that you actually own the pony you are registering, it merely commemorates and recognizes the name you (or your group) have chosen for the pony and allows you to share the story behind why you got the buyback and how it's name was chosen or what it means to you to be part of the foal's buyback group. All ownership of the pony remains with the Chincoteague Volunteer Fire Company (CVFC). The International Chincoteague Pony Association & Registry has no affiliation with the CVFC.

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When filling out this form you will be asked for

A copy of your auction receipt or some form of proof that you are the owner of the buyback or part of the buyback group that purchased the foal. If you are unsure of your eligability, please contact us

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Buyback owners name to be listed on the certificate* This field is required.If you are in a buyback group this must match the name that you donated under

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Name of person certificate should be mailed to* This field is required.

First Name

Last Name

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Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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Phone Number* This field is required.

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Email* This field is required.

example@example.com

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Registered Name Choices & Preferred Nickname* This field is required. Please include three name options for you pony *ICPAR has the right to disallow names that are unsuitable or similar to a previously registered names at its discretion. Please note the preferred nickname in (parentheses)

If you are part of a buyback group, please list the agreed upon name here and leave the following fields blank

Registered Name Choice #1

Registered Name Choice #2

Registered Name Choice #3

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Pony InformationIf you do not know an answer, please leave it blank

Color

Sex

Date of Birth or year foaled

Markings (Tobiano, Splash or solid)

Auction Price

Auction Number

Sire's Name (Stallion/Father of buyback)

Dam's Name (Mare/Mother of Buyback)

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How was this Pony bought?* This field is required.

By a single person

As a group effort (2-10 people)

As a group effort (11-25 people)

As a group effort (26-100 people)

As a group effort (101-500 People)

As a group effort (501+ people)

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Name of Buyback GroupIf applicable, if not leave this blank

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Are you the PRIMARY Donor of the pony?* This field is required.The person who PAID for the pony at the auction and will have your name listed on the receipt

YESNO

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If you are NOT the primary donor of the pony please include the GROUP NAME, FULL NAME and CONTACT INFORMATION of the primary donor or group leader so we can confirm your buyback donorship and the pony's name.* This field is required.

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Important submission information below, please read before you continue

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Auction Receipt or some form of proof that your are a donor for this buyback foal* This field is required.Please make sure your file is completely uploaded before continuing. If it is not, you will have to re-fill out the form when you try to submit.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

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Extra Upload area if neededPlease make sure your file is completely uploaded before continuing. If it is not, you will have to re-fill out the form when you try to submit.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

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*Please note that by submitting information to or registering with the International Chincoteague Pony Association & Registry your pony's information will show up on our website and the "Chincoteague Pony Pedigree Database." (a public database that records Chincoteague pony names and bloodlines) * This field is required.by submitting this form I understand that the information regarding my pony that is being submitted will be published on the International Chincoteague Pony Association & Registry's website and the Chincoteague Pony Pedigree Database website

I have read and agree to the above statement

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PRIMARY Donor name will NOT be listed on the Chincoteague Pony Pedigree Database or ICPAR's website, unless it has been previously recorded. If you would like any of this information listed please check the boxes below.* This field is required.Primary donors are the ones that have their names listed on the auction receipt. If you are not a primary donor please hit "N/A"

N/A

None

Primary Donor Name

Purchased in memory of

Primary Donor name & Purchased in memory of

Other

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If "Other" was chosen please fill in the blank below

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If you are NOT a primary donor would you like your name listed on ICPAR's website as one of the buyback Donor's?* This field is required.

Yes

No

I am I primary donor and have chosen in the previous question

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In addition to the pony being listed on the CPPD's website, each registered buyback will have a page on the International Chincoteague Pony Association & Registry's website. This page will highlight the buyback donor(s) and why they chose the pony and the significance of the pony's name.This will preserve the pony's buyback history and pay tribute to their donor(s). These write ups can be done anonymously if the buyback donor(s) would like to remain unknown. Would you like us to send you a questionnaire to fill out for your buyback pony's page?* This field is required.

YESNO

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Additional Comments

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If you are planning on registering more than one buyback within the next several weeks please indicate below & label like the following (1 of 2) or (I will be registering 3 ponies) If you are only registering one pony please put (1) in the box below * This field is required.

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The International Chincoteague Pony Association & Registry LLC (ICPAR) exists to preserve, protect, and promote the Chincoteague pony Breed. ICPAR recommends and expects that all persons will conduct themselves in an honest, forthright, ethical, and sportsmanlike manner in their relationships with each other at any time they are involved in Chincoteague pony-related matters. *SUBMISSION AGREEMENT: By submitting this application and accepting the benefits of transacting business with the ICPAR, I hereby subject myself to all the provisions of the Buyback registration rules, By-Laws, Rules and Regulations, Code of Conduct & Grievancy Policy, and the Privacy Policy of the International Chincoteague Pony Association & Registry LLC, as they now exist or may, be amended. Knowledge of which I currently have or will immediately acquire from the Registry by emailing chincoteagueponyassociation@gmail.com or online at www.chincoteagueponyassociation.com. All information is correct to the best of my knowledge and belief as certified by my submission of this form and signature below. Any fraudulent statements herein automatically cancel registration.* This field is required.

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Thank you for registering with us!If you have any questions or comments on how we can improve our services, please write them here.

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When you have submitted this form you will be automatically directed to the payment link. If you are registering multiple ponies you can pay for them all in one transaction either with your first pony's application or last pony's application.* This field is required.