2016 All Dressage Association

Membership Application

New Member / Renewing Member
Name: / ADA #:
Address: / USDF #:
Registered and plan to show in USDF Shows?
Check here and include USDF Horse # below.
City:
State: / Zip: / Phone:
Email: / (please print clearly)
Horse Name(s): / USDF #:
Horse Name(s): / USDF #:

Please list horse’s barn / show name (as listed on Coggins) ~ additional horses can be listed on back of form.

MEMBERSHIP FEES*
Membership term – December 1, 2015, through November 30, 2016
Date of Birth
(USDF Requirement)
$50.00 / JR. / YG Rider -- 15 and under = Jr. Rider, 16-21 = YG Rider
(Age considered is the rider’s age as of Jan. 1 of competition year) / (mm/dd/yyyy)
$50.00 / Adult Amateur– over 21, no income from riding or training / (mm/dd/yyyy)
$50.00 / Open -- an adult (over 21) who makes income (cash or other recompense) from riding/training/teaching / (mm/dd/yyyy)
$30.00 / Non-Competing / Social–Qualifies for member rates at ADAclinics and social events. Receives USDF member benefits but does not show at ADA or USDF shows.
$_____ / Family – After first Member Fee of $50, the fee for each Additional Household Memberis $20.
List each additional household member on back of the form providingName, ADA #, USDF #, D.O.B and Horse.
* Includes USDF members benefits, such as discounted rates at USDF events and 10 issues of the award-winning USDF Connection magazine (see membership page of alldressageassociation.com for details).
Office use only:
$ Paid / Check # / Date / Postmark Date

IMPORTANT: For points from a specific competition to be considered for year-end awards, the membership application must be submitted prior to that competition.Registration must be postmarked, or e-mailed received, a minimum of one day before the competition. Membership forms can be emailed or sent by post.

Direct questions or send registration forms to Allison Trumbull, membership chair for 2016:

Phone:616-889-2612

Email:

Mail:Membership Chair

1100 Rosalie Ave NW

Grand Rapids, MI 49504

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2016 All Dressage Association

Membership Application

Continued

Additional Household Member’s Name(s):
Rider Name: / ADA #: / USDF #:
Date of Birth (MM/DD/YYYY): / Email:
Horse Name(s): / USDF #:
Email address:
Rider Name: / ADA #: / USDF #:
Date of Birth (MM/DD/YYYY): / Email:
Horse Name(s): / USDF #:
Email address:
Additional Horse’s Name(s):
Horse Name(s): / USDF #:
Horse Name(s): / USDF #:

Please list horse’s barn / show name (as listed on Coggins)

Please read and initial:
I acknowledge that show rules follow USDF guidelines. These rules as well as regulations for memberships and year-end awards can be found within the omnibus. The omnibus is located online at Ialso acknowledge that it is each individual member’s responsibility to familiarize themselves with these rules.
I will notify the ADA of any changes in; personal data, names of registered horses to be used in the A.D.A. Shows, individual show levels and or membership status (i.e. amateur to open).
Please mark your preference:
ADA has my permission to use my / my child’s photograph on the ADAwebsite,social media pages, miscellaneous advertising, etc. / Yes / No
Referred by:
Signed: / Date:
Signed: / Date:

Parent signature, if registering member is under 18 years of age

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