Shows

Silvermine Farm, LLC.

Norwalk, CT

Shows

Silvermine Farm Horse Show

Date:____________________

<> <> <> <> <>

Name of Horse (only one horse per entry blank)

CLASS ENTRIES

Name of Rider

Color

Sex

Height

Age

Total Fee Calculation

USEF

Member No.

Please read and sign the USEF Entry Agreement on the reverse side of this form. Photo copied entries must include both sides of this form. Please print all information.

Name of Owner:____________________________

Address:___________________________________

City, State, Zip:_____________________________

Telephone No.:______________________________

Social Security No.:__________________________

Name of Trainer:____________________________

Address:___________________________________

City, State, Zip:_____________________________

Telephone No.:______________________________

Name of Rider:____________________________

Address:___________________________________

City, State, Zip:_____________________________

Telephone No.:______________________________

If you would like to be on our mailing list, please provide your email address:

_________________________________________

Please make checks payable to Silvermine Farm

ENTRY FEES ______________ x _____________ =

No. of Classes

Rider

Owner

Trainer

USEF Non-Member Fee @ 30.00

Horse

USHJA Non-Member Fee @ 30.00

ASPCA

CHJA

USEF Fee @ 8.00 Drug Fee @ 7.00

15.00

NEHC

Age Junior

Silvermine Farm Training Fee

Age Amateur

TOTAL AMOUNT DUE

Office Use

Measurement Card

Amateur Card

Silvermine Farm Horse Show

80 Comstock Hill Road

Norwalk, CT 06850

Federation Entry Agreement

By entering a Federation-licensed Competition and signing this entry blank as the Owner, Lessee, Trainer, Manager, Agent, Coach, Driver, Rider, Handler, Vaulter or Longeur and on behalf of myself and my principals, representatives, employees and agents, I agree that I am subject to the Bylaws and Rules of The United States Equestrian Federation, Inc. (the “Federation”) and the local rules of the competition. I agree to be bound by the Bylaws and Rules of the Federation and the competition. I will accept as final the decision of the Hearing Committee on any question arising under the Rules, and agree to release and hold harmless the competition, the Federation, their officials, directors and employees for any action taken under the Rules. I represent that I am eligible to enter and/or participate under the rules, and every horse I am entering is eligible as entered. I also agree that as a condition of and in consideration of acceptance of entry, the Federation and/or the competition may use or assign photographs, videos, audios, cable-casts, or other likenesses of me and my horse taken during the course of the competition for the promotion, coverage or benefit of the competition, sport, or the Federation. Those likenesses shall not be used to advertise a product and they may not be used in such a way as to jeopardize amateur status. I hereby expressly and irrevocably waive and release any rights in connection with such use, including any claim to compensation, invasion of privacy, right of publicity, or to misappropriation. The construction and application of Federation rules are governed by the State of New York, and any action instituted against the Federation must be filed in New York State. See GR908.4.

Federation Release, Assumption of Risk, Waiver, and Indemnification

This document waives important legal rights. Read it carefully before signing.

I AGEE in consideration for my participation in this Competition (Silvermine Farm Horse Show) to the following:

I AGREE that I choose to participate voluntarily in the Competition with my horse, as a rider, driver, handler, vaulter, longeur, lessee, owner, agent, coach, trainer, or as parent or guardian of a junior exhibitor. I am fully aware and acknowledge that horse sports and the Competition involve inherent dangerous risks of accident, loss, and serious bodily injury including broken bones, head injuries, trauma, pain, suffering, or death (“Harm”).

I AGREE to release the Federation and the Competition from all claims for money damages or otherwise for any Harm to me or my horse and for any Harm caused by me or my horse to others, even if the Harm resulted, directly or indirectly, from the negligence of the Federation or the Competition. The NEHC is also held harmless.

I AGREE to expressly assume all risks of Harm to me or my horse, including Harm resulting from the negligence of the Federation or the Competition.

I AGREE to indemnify (that is, to pay any losses, damages, or costs incurred by) the Federation and the Competition and to hold them harmless with respect to claims for Harm to me or my horse, and for claims made by others for any Harm caused by me or my horse at the Competition. I have read the Federation Rules about protective equipment, including GR801 and EV113, and I understand that I am entitled to wear protective equipment without penalty, and I acknowledge that the Federation strongly encourages me to do so while WARNING that no protective equipment can guard against all injuries.

If I am a parent or guardian of a junior exhibitor, I consent to the child’s participation and AGREE to assume all of the obligations of this Release on the child’s behalf.

I AGREE that “the Federation” and “Competition” as used above includes all of the officials, officers, directors, employees, agents, personnel, volunteers and affiliated organizations.

I AGREE that if I am injured at this competition, the medical personnel treating my injuries may provide information on my injury and treatment to the Federation on the official USEF accident/injury report form.

I represent that I have the requisite training, coaching and abilities to safely compete in this competition.

BY SIGNING BELOW, I AGREE to be bound by all applicable Federation Rules and all terms and provisions of this entry blank.

Rider/Driver/Handler/ Owner/Agent Trainer Coach

Vaulter/Longeur (mandatory) (mandatory) (mandatory) (if applicable)

Signature:____________________ Signature:___________________ Signature:___________________ Signature:___________________

Print Name:__________________ Print Name:__________________ Print Name:__________________ Print Name:__________________

Parent/Guardian Signature: (Required if Rider/Driver/Handler/Vaulter/Longeur is a minor)_________________________________________

Print Parent/Guardian Name:_______________________________________ Emergency Contact Phone No.___________________________

Is Rider/Driver/Vaulter a U.S. Citizen: _____Yes _____No

Silvermine Farm

80 Comstock Hill

Norwalk, CT 06850

FIRST CLASS MAIL

Member of the

Fairfield/Westchester PHA

High Score Awards Program

SILVERMINE FARM

HORSE SHOWS

Thursday June 25, 2009

#263686 “C” rated

Judge: Ken Okken – Vernon, NJ
Steward: Diane Hatt – Warwick, NY
Tuesday July 7, 2009

#244728 “C”rated

Judge: Joy Dunn – Oneonta, NY
Steward: Dorothy Darnell – Newburgh, NY
Tuesday July 14, 2009

#295213 “C”rated

Judge: Beth Stolz – Redding, CT
Steward: Ken Okken – Vernon, NJ
Saturday August 22, 2009

# 314650 rating to be announced

Judge: Christine Dwyer – Shenorock, NY
Steward: Diane Hatt – Warwick, NY

FWPHA NEHC CHJA USEF

For Information:

Phone: (203)846-2098 Fax: (203)846-0810

80 Comstock Hill Rd. Norwalk, CT 06850

www.silverminefarmllc.net

Silvermine Farm

80 Comstock Hill

Norwalk, CT 06850

FIRST CLASS MAIL

Member of the

Fairfield/Westchester PHA

High Score Awards Program

FWPHA NEHC CHJA USEF

For Information:

Phone: (203)846-2098 Fax: (203)846-0810

80 Comstock Hill Rd. Norwalk, CT 06850

www.silverminefarmllc.net

Time Schedule:

8:00 am Start

1. NEHC Junior Medal

2. CHJA Junior Medal

3. PHA Medal

4. PESSOA/USEF National Hunt Seat Medal

5. NHSAA/ASPCA MACLAY

6. USEF Talent Search

7 - 9. Junior Hunter

10. Junior Hunter U/S

11-13. Children’s Eq. Fences

14. Children’s Eq. Flat

15. CHJA Children’s Medal

16-18. Children’s Hunter Pony

19. Children’s Hunter Pony U/S

20-22. Children’s Hunter Horse

23. Children’s Hunter Horse U/S

24. Open Pleasure

25. NEHC Pleasure

26. Open Pleasure O/F (once around xrails)

27-28. Short Stirrup Fences

29. Short Stirrup Walk-Trot

30. Short Stirrup Walk-Trot-Canter

31-33. Schooling Hunter

34. Schooling Hunter U/S

35-36. Walk-Trot Equitation Flat

37. Walk-Trot Eq. Ground Poles

38-40. Low/High Hunter (2’6, 3’0)

41. Low/High Hunter U/S

42. NEHC Adult Medal

43. CHJA Adult Medal

44-46. Adult Hunter

47. Adult Hunter U/S

48. LEADLINE* To be held at noon

PLEASE NOTE THAT ONLY THE CHJA MEDAL WILL RECEIVE POINTS

ON THE WEEKDAY SHOWS. CHILDREN’S, JUNIOR AND ADULT

AMATEUR HUNTER DIVISIONS ARE ALSO RECOGNIZED BY THE CHJA

FOR POINTS ON THE SATURDAY DATE.

Every class offered herein which is recognized by the CHJA will be conducted

and judged in accordance with the current CHJA rules. To show in CHJA Medal

classes, riders must be members. In order to compete for CHJA annual year-end

awards, the owner of the horse or pony must be a member of the CHJA and the

horse or pony must be registered with the CHJA. A copy of the CHJA rule book,

class specifications, medal class specifications, and membership applications are

available at the show secretary’s office and at WWW.CHJA.NET

THE FOLLOWING CLASSES ARE RATED NEHC “C”: 7, 8, 9, 10, 16, 17, 18,

19, 20, 21, 22, 23, 25, 27, 28, 35, 36, 44, 45, 46 AND 47. Silvermine Farm and

the NEHC are waived of any responsibility to riders in these competitions.

Directions to Silvermine Farm

80 Comstock Hill, Norwalk, CT 06850

From I-95:

Exit 15 (Route 7 Extention) to exit 2. Turn right at traffic light. Go

under Highway. At 2nd light, turn right onto Route 123. At Shell

Gas Station, turn right onto Silvermine Ave.. Follow to 2nd stop

sign. Turn left onto Comstock Hill. Silvermine Farm is about 0.8

mile up on the right side.

From Merritt Parkway:

Northbound: Turn right under parkway. At 2nd light rurn right onto

Carter Street.

Southbound: Continue straight through light at end of ramp onto

Carter Street.

Go about 100 yards on Carter Street. Take 1st right onto Pocconoc

Trail. Follow to end. Turn right onto Buttery Road. Follow to end.

Turn right onto Comstock Hill. Silvermine Farm is on the left.

From the North:

Route 35 to Route 123. Take 123 through Vista, NY. At 2nd light,

turn left onto Route 106. Follow to 1st stop sign. Turn right. At next

stop sign, turn right onto Comstock Hill. Go up hill. Silvermine

Farm is on the left side.

Manager and Course Designer: Ken Markosky

Secretary: Joan Healy, Fairfield, CT

Veterinarian on call: New England Equine Practice (845)878-7500

2009 USEF MEMBERSHIP APPLICATION

UNITED STATES EQUESTRIAN FEDERATION

1. PERSONAL INFORMATION:

TITLE: ? Mr. ? Mrs. ? Ms. ? Miss. ? Other

NAME:

ADDRESS:

City, State , Zip:

Phone:

Evening Phone:

Fax:

E-mail:

U.S. CITIZEN: YES NO IF NO, WHAT COUNTRY?

MEMBER #:

3. BREED/DISCIPLINE AFFILIATION *REQUIRED

All Active Members of USEF must designate a primary breed/discipline affiliation upon

joining or must do so annually upon renewing. Senior Active member designations will be

used to determine proportional representation on the USEF Board of Directors (GR201).

Please select your primary breed/discipline affiliation (1) and you may select another as a

secondary choice (2). EXAMPLE: 1 Hunter 2 Driving

____Andalusian/Lusitano ____ Arabian/Half-Arabian/Anglo-Arabian/National Show Horse

____Connemara _____ Dressage _____ Driving _____ Endurance _____ Eventing

____ Friesian ____ Hunter _____ Jumper _____ Morgan ____ Paso Fino ____Reining

____Saddlebred/Hackney/Roadster/Shetland/Parade _____ Vaulting _____ Welsh

____ Western ______Other___________________________________________

6. UNITED STATES EQUESTRIAN FEDERATION MEMBERSHIP

USEF COMPETING EQUESTRIAN

To be able to participate at a USEF Licensed Competition as a rider, driver, handler, vaulter, longeur,

owner, lessee, agent, coach, trainer, competition manager, or competition secretary you must join as

a competing member. (Exceptions found in GR901.9) ? SENIOR ACTIVE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $55 ___

(Membership benefits for the competition year. Breed/Discipline Dues no longer required.)

? JUNIOR ACTIVE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$55 ___

(Individuals who have not reached their 18th birthday on 12/01/08.)

? LIFE MEMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$2500 ___

USEF NON-COMPETING EQUESTRIAN (For individuals not competing in USEF Licensed

Competitions. This does not qualify as an active membership for horse owners, licensed officials,

competition managers or secretaries.)

? USEF EQUESTRIAN (includes automatic insurance and MemberPerks). . $35 ___

? CLUB EQUESTRIAN (includes MemberPerks). . . . . . . . . . . . . . . . . . . $15 ___

? Non-Member Amateur Card (Complete section 4). . . . . . . . . . . . . . . $30 ___

USEF TOTAL $

9. UNITED STATES HUNTER JUMPER ASSOCIATION MEMBERSHIP

In order to compete as a rider, trainer, owner, his/her agent(s) at non-breed restricted USEF

licensed competitions in any Hunter, Hunter-Breeding, Jumper or Hunter Seat Equitation

classes, a person must be a member of the United States Hunter Jumper Association, Inc.

or pay a $30 non-member fee to the USHJA at each competition (Exception: Local

competitions and exceptions in GR202.1and GR901.9). Your USHJA dues include $9 for a

one year subscription to In Stride magazine.

? ACTIVE member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $55 ___

? LIFE member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1000 ___

USHJA Total $

The United States Equestrian Federation/USEF membership year begins on December 1. All memberships (except Life) expire on November 30. The effective date of membership is the date on

which the application and correct dues are received by the USEF office. If you join at a competition, the effective date is the start date of the competition provided the application and dues are

received by the Competition Secretary, and the application is signed and dated by the Competition Secretary during the period of the competition (Exception: Dressage Competition GR201.7).

To be eligible for USEF Awards including Farnam®/Platform™ USEF Horse of the Year Program you must be a Senior Active, Junior Active, or Life Member. By submitting this application, you

agree all information is correct and you agree to abide by all USEF rules. Annual dues for Senior and Junior members include $16 for a one year non-deductible subscription to

magazine.

5. EQUESTRIAN MAGAZINE

? My household receives multiple copies of the USEF official publication

please do not send an additional copy to me.

4. Amateur /Profesional Status *required

Each individual, 18 years and older, MUST sign and check the appropriate box below. If you

have not participated in any professional activities as cited in GR1306, you are considered

an amateur. Amateur status is also required for anyone who competes in amateur classes. By

signing below, you confirm that you have read & understand USEF GR1306-GR1308.

? A mateur (Sign in ink)

? ProfesSional (Sign in ink)

Please note: Individuals who sign as a professional must complete the amateur reclassification process prior to being

reinstated as an amateur. See GR1308 for details of this process.

7. USEF RULE BOOK

You can view the entire USEF Rule Book and Competition Calendar on the internet at our

website, www.usef.org.

No: ? I do not need the rule book and can access it online.

? I received a USB flash drive in 2008

Yes, I would like to receive the 2009 USEF Rule Book in the following format:

? USB flash drive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $0 ___

? Printed Version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $10 ___

8. OLYMPIC/INTERNATIONAL EQUESTRIAN TEAM USA

Contribute to EQUESTRIAN TEAM USA Success

____$15 ____$25 ____$50 ____$100 Other ________TOTAL $

Your contribution is tax deductible to the extent permitted by law.

10. RENEWAL

? No, I do not wish to receive a paper renewal form in 2010. I will renew online.

Payment (Total of 6,7,8 and 9) (Do not send cash) . . . . $__________________

?Check/ Money Order (Payable to USEF) ?VISA ?MasterCard ?AMEX

Card Number:

Exp. Date: / / Billing Zip Code:_____________________

Card Holder Name (Print)

Card Holder Signature

? ?

Please use a separate aplication for each member

2. date of birth *required

(mm/dd/yy): / /