ECTRA Outside Mileage Form

OUTSIDE MILEAGE FORM (Effective 2017)

Submit within 30 days of Event. (Please use one form per event)
Rider ECTRA #*
Enter N/A if Rider is Not a Member
First Name*
Last Name*
E-mail*
Horse ECTRA #*
Enter N/A if Horse is Not a Member
Horse Name*
# of Days*
Type of Ride:*
Event Name*
Event Date*
Event State*
Sanctioning Organization*
Manager/Secretary Name*
Manager/Secretary Email*
Day 1 Mileage
Day 1 Ride Time
Day 2 Mileage
Day 2 Ride Time
Day 3 Mileage
Day 3 Ride Time
Day 4 Mileage
Day 4 Ride Time
Day 5 Mileage
Day 5 Ride Time
AERC LD is eligible for outside mileage , BUT IT DOES NOT COUNT FOR ANY ECTRA AWARDS. ONLY COUNTS AS LIFETIME MILEAGE.

This is to certify that the above information is correct and that the ride was successfully completed and that there were NO cash awards at the event.

If any information on this form is found to be incorrect, the owner, rider and the horse may lose all points and mileage for the current ECTRA year.

If information is sent AFTER 30 days of the event date, outside mileage credit will NOT be given,

Outside mileage cannot be purchased through the ECTRA Back Mileage program.

If I am signing and submitting this Agreement electronically, I acknowledge that my electronic signature shall have the same validity, force and effect as if I affixed my signature by my own hand.
Rider Name*
I Agree*

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Date

MonthDayYear
Click the Submit Button below to automatically send to ECTRA Mileage Chair
If submitted electronical you DO NOT need to mail printed copy

This form may also be printed and mailed to:

Beth Sheldon
4150 Upper Ridge Rd
Pennsburg PA 18073
Should be Empty:

OUTSIDE MILEAGE FORM (Effective 2017)