Rider Name: _____________________________________________________________________
SR _________ JR _________ (Birthdate if junior) _____________ Disabled: __________________
Horse Name: _________________________________ Date of Negative Coggins: _____________
(Include copy of your horse’s Coggins with your entry)
VADA/Nova member: YES NO
Address: ________________________________________________________________________
Telephone Number: ___________________ E-Mail Address: ______________________________
Test: ______________________________ Test: _____________________________________
Total Amount for Entry: _________ Minus total “Volunteer Bucks” or vouchers enclosed: _______ = Total $ Amount Enclosed: ________________
Make check payable to VADA/Nova, Inc.
Note that members get priority in filling the available ride times for all VADA/Nova schooling shows. You may send in your membership with your show entry. Membership form available on the web site at www.vadanova.org
Neither VADA, VADA/Nova, its officers, nor any of the facilities or officials are responsible for any accident, injury, or property damage.
Signature of Rider (or parent if junior): ___________________________________________
Sometimes accidents do happen. In case we need to get in touch with an emergency contact for you on the day of the show, please provide:
Emergency Contact Name: _______________________ Phone Number: _________________
| Intro B | 62% | Training 4 | 60% | |
| First 4 | 58% | Second 4 | 58% | |
| Third 3 | 57% | Fourth 3 | 57% | |
| FEI Levels | 57% | MFS (TR – 4th) | 60% |