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COMBINED ENTRY FORM
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COMBINED ENTRY FORM 2008
EVENT ENTERED............................................................................................................................. DRIVER'S NAME.............................................................................................................................. ADDRESS ........................................................................................................................................... .............................................................................................................................................................. POST CODE ................................. E-MAIL .................................................................................... TELEPHONE ................................................FAX ............................................................................ MOBILE ............................................................................................................................................ PLEASE CIRCLE THE CLASS YOU WISH TO ENTER NOVICE PONY / NOVICE PONY QUALIFIER / NOVICE HORSE QUALIFIER / OPEN PONY / OPEN HORSE / PONY MULTIPLES / HORSE MULTIPLES PONY/HORSE NAMES: 1 ............................................. 2 ............................................................... 3 ............................................. 4 ................................................................ MARATHON COLOURS: ................................................................................................................. Do you require a competence form to be signed? YES / NO WHHC Member's Entry Fees: Inside-Out £25 / 1 Day event £45 / 2 Day Event £70 Non -Members Fees: Inside Out £35 / 1 Day Event £55 / 2 Day Event £80 ALL CHEQUES PAYABLE TO WHHC - TOTAL ENCLOSED = £ DISCLAIMER: IACCEPT ON BEHALF OF MYSELF AND ALL PERSONS ACCOMPANYING ME THAT NEITHER THE WHHC OR ANY AGENT, REPRESENTATIVE OR ANY MEMBER OF THEM, SAVE IN RESPECT OF DEATH OR PERSONAL INJURY CAUSED BY NEGLIGENCE OF THE ORGANISERS FOR ANYONE THEY ARE IN LAW RESPONSIBLE, ACCEPTS ANY LIABILITY FOR ANY ACCIDENT, LOSS, DAMAGE, INJURY OR ILLNESS TO ANY HORSE, DRIVER, GROOM, PASSENGER, SPECTATOR, LAND OR ANY OTHER PERSON OR PROPERTY WHATSOEVER, WHETHER CAUSED BY THEIR NEGLIGENCE, BREACH OF CONTRACT, STATUTORY DUTY OR IN ANY OTHER WAY WHATSOEVER. I CERTIFY THAT I AM COVERED TO FEI STANDARD BY MY OWN INSURANCE. THIS SECTION MUST BE COMPLETED, IF NOT, ENTRY WILL BE DECLINED Name of Insurance Co ........................................................... Policy No: ...................................................................... BHDTA Full / Associate Membership ................................. Membership No: ........................................................... Signed ..................................................................................................Date ..................................................................... If driver is under 16 years old Driver's date of Birth Gaurdian's Signature ......................................................................... (If under 16) ......................................................... SEND completed form, photocopy of your insurance cover & entry fee payable to WHHC to: Entries Secretary: Brenda May. Coulsdon, Wootton Road, Tiptoe, Nr Lymington, Hampshire, SO41 6FU.
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