2025 National Examiner Clinic Rider Registration-Spring

National Examiner Mounted Clinic Rider Registration

Registration Due by March 16
Participant Info
Name*
Age*
Club/Center Name*
Club/Center Name
Address*
City/State/Zip*
Mobile Phone*
Format: (000) 000-0000.
E Mail*
example@example.com
Current HM Certification*
HM Certification
Current Flat Certification*
Over Fences Certification
Current Over Fences Certification*
Over Fences Certification

Current Competition Levels

If not currently competing, indicate the jump height you've been working at in the past month.
Flat*
Over Fences*

Emergency Contact Info
Name*
Relationship*
Mobile Phone*
Format: (000) 000-0000.

Mount Info
Age*
Breed*
Gender*
Highest Competition Level*
Please upload a current negative Coggins.*

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Please upload proof of vaccination for Influenza and Rhinopneumonitis (EHV-1/4)*

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Pay by Credit Card or PayPal
Registration Fees*
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NE Clinic Auditor/Seminar Participant
One grounds person can attend for free with each rider. Use this field for any others attending with you in addition to your grounds person.

$20.00



NE Clinic Flat Lesson Only
Can audit entire clinic

$75.00



NE Clinic Jump Lesson Only
Can audit entire clinic

$75.00



NE Clinic Flat & Jump Lesson
Can audit entire clinic

$140.00



Subtotal

$0.00

Tax

$0.00

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty: