Fire Up Entry Form FEI

Select Ride Distance Sunday Jan 19, 2025

FEI 1* 65 milesFEI 1* YJ 65 milesFEI 2* 75 miles
First Name   Last Name

FEI #   blank

Phone Number   Email
Horse Name blanks Horse Breed blank

Horse Sex Type a label Horse Age Type a label

Horse FEI # Type a label
Horse Owner's Name blanks
Emergency contact blanks
Fees
FEI 1* $800
FEI 1* YJ $650
FEI 2* $850

Postmark after 1/16 add $20 late fee
Total $*
You can pay from usier.org clicking on "donation", or

Mail completed entry and check to:

Anastassia Savini

Po Box 2591

San Pedro, CA 90731

Venmo: @AnastassiaSavini

Zelle: (424)3357262

Paypal: usierinfo@gmail.com

Questions? Call Ana (Gia) at (424) 3357262 or email anastassia.savini@gmail.com

FEI payments can be split in installment payments, just reach out and let me know!

If we reach enough entries we will reimburse part of the entry fee.
Rider's Signature*

Clear
Date

MonthDayYear
Date
Should be Empty: