GOLD COUNTRY 50/30 MILE ENDURANCE RIDES

                   SATURDAY, July 14, 2012      ENTRY FORM

           PLEASE NOTE - THE RIDE IS LIMITED TO 140 RIDERS     

Rider Name ________________________________________________AERC# _______________
Address___________________________________________________Phone_________________
City______________________________________________________ State _____ Zip _________
Junior Riders (under 18 years) Birthdate ________________________________________________
Name of Junior’s Sponsor____________________________________________________________
Name of Horse __________________________________________________ AERC# ___________
Age ____ Color ______________ Breed ________________ Sex: (circle)   Gelding    Mare   Stallion
Owner________________________________ Address____________________________________
Will you be arriving after dark on Friday, July 1st? (circle)   Yes   No    Rig size in feet? __________
Will you be driving your own rig or with someone else? (name) ______________________________
Truck Mfg. ________ Color ________ License _________ Trailer Mfg._________ License ________
In case of emergency contact: ___________________________________ Phone # _____________
   Are they here with you? __________

  ______ Sr. Division Featherweight (Rider with tack, up to 160 lbs.)
  ______ Sr. Division Lightweight(Rider with tack, up to 185)
  ______ Sr. Division Middleweight(Rider with tack, up to 210 lbs.)
  ______ Sr. Division Heavyweight(Rider with tack, over 211 lbs.)
  ______ Jr. Division

MAKE CHECKS PAYABLE TO GOLD COUNTRY ENDURANCE RIDERS OR GCER
Entry Fees:
30 Miler - $75 (Juniors and Ride Managers - $37.50) __________
50 Miler - $90 (Juniors and Ride Managers - $45) __________
What AERC ride managed in 2012? ___________________________ __________
Non-AERC Member Fee - $15.00 (Both 30 & 50 Milers) __________
Post marked before July 1st - subtract $15 __________
# Of Extra Banquet Tickets @ $10.00 _________ x $10.00 __________
Total Enclosed (READ AND SIGN RELEASE) __________
Vegetarian meal? _____

$8 camping fee is payable to Forestry – see “Entry Fees” section on ride information page

Send completed entry form/check and Liability Release to:
GCER c/o Randy Hackbarth, 5152 Metate Trail, Placerville, CA   95667

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Updated: 03.22.12 jds