Rider Registration
SWIT & DR Old Selam 2026
Full Name
*
First Name
Last Name
E-mail
example@example.com
Phone Number
*
Format: (000) 000-0000.
Emergency Contact
First Name
Last Name
Emergency contact phone number
Please enter a valid phone number.
Format: (000) 000-0000.
AERC number
PNER number
Junior? (Yes/No)
Weight Division
Featherweight
Lightweight
Middleweight
Heavyweight
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
50 and 25’s are $145. Intro Trail rides (with vet checks before and after) are $35, the 75 is $190, and the $100 is $250.
DAY 1. September 4, 2026
Distance (50,25, Intro Trail)
Please Select
Day 1 50 miles.
Day 1 25 miles.
Day 1 IntroTrail ride.
Horse AERC number
Horse Name
Horse PNER number
DAY 2. September 5, 2026
Distance (50, 25, Intro Trail)
Please Select
Day 2 50 miler.
Day 2 25 miler.
Day 2 Intro Trail ride
Horse Name
Horse AERC number
Horse PNER number
DAY 3. September 6, 2026
Distance (100, 75, 50, 25, Intro Trail)
Please Select
Day 3 100 miles.
Day 3. 75 miles.
Day 3 50 miles.
Day 3 25 miles.
Day 3 Intro Trail ride.
Horse AERC number
Horse Name
Horse PNER number
Signature
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