2026 AERC NC & Old Dominion Entry Form

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Todays Date* This field is required.EARLY BIRD DEADLINE IS CLOSED AS OF Midnight Monday, June 2nd. An ADDITIONAL $50 will be automatically added to your entry fee total, if you register AFTER June 2nd.

Date

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Submission Type

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Rider AERC #Don't know your AERC number? You can find it on the AERC webpage Member Home/ My Info

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Rider Name* This field is required.

First Name

Last Name

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AERC Weight Division* This field is required.These weights include all tack. If you are not an AERC member, an estimate is fine. J = Juniors (under the age of 16 on 12/1/2024) YR = Young Rider: For riders from 16-21 as of the first day of the ride season FW = Featherweight (up to 160 pounds) LW = Lightweight (161-185 pounds) MW = Middleweight (186-210 pounds) HW = Heavyweight (211 pounds and over)

FW

LW

MW

HW

JR

YR

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Horse AERC Number (does not have one , leave blank)Don't know your horse's AERC number? You can find it on the AERC webpage https://aerc.org/membership/member-horse-lookup/

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Horse Name* This field is required.

Enter TBD if horse is undecided

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Ride day and Distance* This field is required.Select Which Day and which distance

55 NC Thurs

25 OPEN Fri

55 OPEN Fri

100 OPEN Sat

100 NC Sat

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Is this rider a Junior?* This field is required.J = Juniors (under the age of 16 on 12/1/2024)

YES

NO

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If Junior, riders birth date

Born after 12/1/2008

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Sponsors NameIf rider is a Junior. (Born after 12/1/2008)

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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.

Please enter a valid phone number.

15

Email* This field is required.

example@example.com

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Emergency Contact Information* This field is required.Please provide a name and phone number of your emergency contact

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Horse Breed

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Horse Gender

Gelding

Mare

Stallion

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Horse Color

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Horse Owner's Name* This field is required.

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Upload Coggins (Current within the last 12 months)

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

Browse Files

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Rider ECTRA # (if applicable)

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Horse ECTRA # (If applicable)

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First AERC Ride?

YESNO

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Are you an AERC Member?* This field is required.MUST BE A CURRENT AERC MEMBER to participate in the NC division. FOR OPEN division: AERC has increase the Day membership fee to $20

YES

NO ($20 AERC Day Fee will be applied) (only applies to open division)

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ONLY ANSWER FOR OPEN DIVISION ENTRY OD Member? (ONLY APPLIES TO OPEN DIVISION ENTRIES)Is the rider a Member of the Old Dominion Equestrian Endurance Organization? (This is different from AERC Membership) Want to become an OD member and receive discounts on all ride entries and be eligible for the OD Triple Crown? Go to: https://www.olddominionrides.com/membership

YES NOT APPLICABLE for NC division (A $5 discount will be applied to your entry fee)

NO

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Are you sponsoring a junior?($20 discount for sponsors)

YES I am sponsoring a junior. (A $15 discount will be applied to your entry fee)

NO

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Entry Fees (SELECT CAREFULLY PLEASE) FEES are the SAME for NC and OPEN* This field is required.IF YOU ARE REGISTERING AFTER June 1st, AN ADDITIONAL $50 will be applied to the amount listed below Please choose carefully: Prices listed below are Early Bird Prices OD members will receive a $5 discount applied at the end FOR OPEN DIVISION ONLY

100 Mile SENIOR ($280)

100 mile JUNIOR ($190)

55 Mile SENIOR ($175)

55 Mile JUNIOR ($135)

25 Mile SENIOR ($130)

25 Mile JUNIOR ($90)

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THURSDAY Meal ticket: Would you like to by extra meal tickets? $15 each*One Thursday meal ticket in included in entry fee for Thursday and Friday riders

1 meal ticket

2 meal tickets

3 meal tickets

4 meal tickets

5 meal tickets

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FRIDAY: Would you like to by extra FRIDAY dinner meal tickets? $15 eachOne Friday meal ticket is included in entry fees for Friday riders and 100 mile riders.

1 meal ticket

2 meal tickets

3 meal tickets

4 meal tickets

5 meal tickets

No Thank You

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SUNDAY BRUNCH: Would you like to by extra SUNDAY BRUNCH meal tickets? $15 each100 mile ride entries include one Sunday Brunch meal ticket

1 Brunch ticket

2 Brunch tickets

3 Brunch tickets

4 Brunch Tickets

5 Brunch tickets

No Thank You

Other

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Payment Method* This field is required.REFUND POLICY: Refunds minus a $50 non-refundable deposit will be issued up through Sunday, June 7th. June 8th-9th a partial refund will be issued on a case by case basis. NO REFUNDS after Tuesday, June 9th. IF PAYING BY PAYPAL OR CREDIT CARD: A $3 service charge will be added to you total NO FEE FOR CHECKs OR ZELLE PAYMENTS Mail checks to: Christine Roberts, 214 Burke St., Plains, PA 18705 If paying by Credit Card or PayPal please go to the OD website AFTER completing this form. https://www.olddominionrides.com/entry-forms and click on payment button

PayPal (+$3 service fee will be added to your total)

Credit Card (+$3 service fee will be added to your total)

Check (Mail to Ride Secretary) Make payable to ODEEO

ZELLE (Use your Zelle account, make payment to (payment@odeeo.org) Bank to Bank transfer NO FEE

Other

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Calculation

THIS IS YOUR TOTAL DUE

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ALMOST DONE:

After reviewing your responses and clicking submit: YOU HAVE 2 MORE STEPS

PLEASE return to the OD webpage to complete your entry registration

STEP 1: Liability Waiver and Treatment Authorization Form:

Click on Liability Waiver and Treatment Authorization form, sign it and SAVE THEM TO YOUR COMPUTER

STEP 2: Scroll down and click on the payment button: select either PayPal, Credit Card or Zelle and follow the instructions.

IF paying by Zelle go to your Zelle account and make payment to (payment@odeeo.org.) This is a bank to bank transfer. Save your confirmation of your transaction and forward to Christine Roberts. See below

Once you have submitted your payment you should receive a confirmation email.

PLEASE DO NOT SEND SCREEN SHOT

PLEASE forward the confirmation email to our ride secretary Christne Roberts

Christine Roberts: Ceroberts11@gmail.com

IF you selected Check, please mail your check and Waiver/Treatment forms to:

Christine Roberts: 90 Benson Hollow Lane, Tunkhannock, PA 18657