ATHRA –“Ride with Pride” Charity Event

Entry Registration Form.

A Registration Form is required for each individual participant.The attached waiver form is also to be signed & sent with the registration.

Name;…………...…………………………………………………..

Address………………………………………………………………………………………………………………………………………………………….

Phone……………………………………………… email;…………………………………………………………………………………..

ATHRA Club...... Member No;......

Emergency Contact;Name...... Ph......

Date of Birth(16 and under only) ...... /...... /......

I the undersigned apply for entry on the ATHRA – Ride with Pride Charity Eventand declare that I have sufficientfitness and possess the horse riding skills needed to participate in this event. Further, I agree to abide by ATHRA’s Code of Conduct for the duration of the event.

Note;

All participants sixteen (16) years and under must be accompanied by a guardianat all times whilst mounted.

Signed......

GuardianName;...... Signed;......

Horse Management

Please nominate the type of yarding you will be using; (please circle)

1)Self provided electric or steel yards

2)Communal paddock

Ride Management

All rides will be conducted under ATHRA’s Code of Conduct.

There are two groups leaving each day, a slower paced group & a faster paced group (more cantering & trotting)

Each group will have their own separate Ride Management Team consisting of a Trail Boss, Lead & Drag Rider, First Aider and Ride Stewards. If you are interested in being part of a Ride Management Team, please complete the following, Discounts do apply on a pro rata basis.

Are you an ATHRA accredited Trail Boss/Ride Coordinator/Ride Steward? Yes/No (please circle)

Are you a qualified first aider?Yes/No (please circle)

If yes, are you willing to be involved in a ride management team during the week? Yes/No (please circle)

If yes, please nominate the number of rides you are willing to officiate in. No. Rides ...... (1 – 6)

Type of Registration (Please circle)

  • Early Bird SpecialAdult$700(Fee paid before 24thAugust 2012)

Junior$500(Junior is under 12, (Fee paid before 24th August 2012)

Full seven days, meals supplied from dinner Saturday night 20th Oct up to & including lunch on Saturday the 27thOct.

  • Late Nomination Adult$850(Fee paid from 25th August upto 5th Oct.)

No registrations will be permitted after the 5th Oct)

Junior$600(Junior is under 12, (Fee paid from 25th August up to 5th Oct.

No registrations will be permitted after the 5th Oct)

Full seven days, meals supplied from dinner Saturday night 20th Oct up to & including lunch on Saturday the 27thOct

  • Part WeekAdult$500(Fee paid by 7th Oct 2011)

Junior$300(Junior is under 12, Fee paid by 7th Oct 2011)

Full four days, meals supplied from dinner Saturday night 20th Oct up to & including breakfast on Wednesday 24th Oct

Or from dinner Wednesday 24th Oct to lunch on Saturday 27th Oct.

(Part Week Offers are only available if ride is not fully booked by full time participants.)

  • Cabin Accommodation
  • Limited in numbers and only available to full week participants
  • Cabin allocation on a first in paid basis. Cabins can sleep up to 4 persons and come with ensuite facilities.

Please contact Juliette Rodowicz 02 4998 3358

  • Donation to Cancer Council (Please circle)

$25$50$100Other $......

  • Fundraising, this event is to raise funds for a very worthy cause;

Few people if any, have not been exposed to the heartbreak of losing a loved one due to cancer. This events sole purpose is not just to provide a wonderful week of riding and fun but to also raise much needed funds to assist in the control of this terrible disease. The Cancer Council of NSW is the beneficiary of all funds raised. All participants are encouraged to undertake a sponsorship drive. A direct deposit website is available for your sponsors, simply go to your profile and your away.

Donations for the Auction on the Tuesday evening will also be gratefully received. Please forward these and/or your ideas to Juliette Rodowicz 02 4998

  • Further information;

For further informationPlease contact Juliette Rodowicz 02 4998

Or Tony Hart on 0419 303 047

  • Merchandise

Ride with Pride/ATHRA Brigalow Shirt (pre paid orders only placed by 14th Sept) $55

(Shirts below are for colour selection and style. They will come with the ATHRA logo and “Ride with Pride” 2012” embroidered on them)

Please Circle selected colour and men or women size.

MENS – SAND, GREEN & NAVY ONLY

For more information go to - brigalowclothing.com/mens-wear/

Size Men’sS - M - L - XL - XXL – XXL

LADIES SHIRTS - WHITE, ROYAL BLUE & MAROON ONLY.

For more information go to - brigalowclothing.com/ladies-wear/

Size Women10 – 12 – 14 – 16 – 18 – 20 – 22 - 24

Payment

Registration...... $......

Accommodation...... $......

Donation...... $......

Merchandise...... $......

Total Payment.....$......

You can register and pay via credit card or bank transfer online by going to and click on “Register”

All paper registrations and paymentsend to;

De’hanne Keir “Ride with Pride” Registrations

110 Cuthill Road

Cobbitty

NSW 2570

Please select Payment TypePlease Circle

Cheque(Please make all cheques payable to ATHRA and include your payment with registration)

Direct Deposit (Preferred option).

BSB...... 062623Account No; ..10096909Account Name; “ATHRA National”

Please ensure your name is endorsed on the transaction with RWP as a prefix to verify your ride payment and email De’hanne with deposit transaction ID ()

e.g. RWP DEHANNE KEIR

Conditions & Cancellations: Full payment is required for all registrations. No position is guaranteed until full payment is received by the Ride with Pride Registration Organiser.

Participant cancellations prior to 21st Sept 2011 a full refund will be given minus a $50 administration charge.

Participant cancellations from and after the 21st Sept 2011 a refund of 50% will be supplied. If you are unable to attend the event you can transfer your registration to an alternative person for no extra charge.

If, due to unforeseen circumstance,the event is cancelled, a full refund will be supplied minus a $100 event management cost.

Note:Payment for any veterinary expenses incurred during the event is the responsibility of the participant

Proudly Supported byLeaders in Equine Nutrition