APPLICATION FOR PROMOTION

Official Veterinarian – Additional Disciplines

Applicant’s Details

Name / Surname
Date of Birth / Nationality
FEI IDNo. / Email
Phone No. / Mobile No.
Address

Disciplines Requested for Promotion

Dressage/Para-Dressage
Driving/Para-Driving / Eventing
Endurance(2*) / Jumping
Reining /
Vaulting

Criteria for Promotion(please tick the boxes if correct)

I am listed as an FEI Official Veterinarian.

I attended a General Veterinarian Course in the past 4 years:

Date / Place / Course Director

Icompleted official mentoring and supervision at a minimum of 1 FEI event for each additional discipline (or 10 FEI/National events for Endurance):

Year / Place / Event Type / Mentor’s Name and FEI ID number

Ihave provided at least 1 positive evaluation form signed by my mentor for each additional discipline (or at least 2 positive evaluation forms for Endurance).

Declaration(please tick the boxes if true)

With my signature, I confirm that:

I have read and understood the current version of the FEI Veterinary Regulations

I acknowledge and accept the FEI Code of Conduct (first section, FEI Veterinary Regulations)

I acknowledge and accept the OV Codex (Annex IV, FEI Veterinary Regulations)

I have read and understood the current version of the FEI Equine Anti-Doping and Medication Control Regulations

I am aware of the FEI Clean Sport webpage and the Veterinary section of the FEI website

The information provided in the present application is correct and true

Date / Applicant’s Signature

Please return your filled in and signed application form and mentors’ evaluation forms to your National Federation. Contact details can be found in the FEI Database under National Federations.


FOR THE NATIONAL FEDERATION’S USE ONLY

The National Federation of hereby certifies that the above-mentioned information is correctand true and wishes to nominate Dr for promotion to Official Veterinarian in the following disciplines:

Dressage/Para-Dressage
Driving/Para-Driving / Eventing
Endurance (2*) / Jumping
Reining /
Vaulting

The National Federation will be charged CHF 40.- for the Official Veterinarian’s stamp.

NF Official Representative

Name
Date / Stamp and Signature

Please return the filled in, stamped and signed application form and mentors’ evaluation forms to the FEI Veterinary Department by email to or by fax to +41 310 47 60.

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