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ANDREAS DIBOWSKI CLINIC APPLICATION

Sponsored by the American Trakehner Association
To be Held at the

Tryon Logo
4066 Pea Ridge Road
Mill Spring, NC 28756

October 31-November 2, 2016


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CLINIC A: October 31, Cross-Country Day; November 1, 1/2 Day Show Jumping

CLINIC B: November 1, 1/2 Day Show Jumping; November 2, Cross-Country Day

CLINIC RIDER COSTS:   ATA MEMBERS - $400* ~ NON-MEMBERS - $450*
CLINIC AUDITOR COST: $45; ATA convention attendees FREE with full registration**

*Applications for riding must be received NLT October 3, 2016

**ATA CONVENTION ATTENDEES AUDITING THE CLINIC MUST FULLY COMPLETE AND SUBMIT THE APPLICATION TO ENSURE ADMITTANCE

 

I prefer to attend: Clinic A Clinic B   (If participating in the MPT at the ATA convention on Nov 2, you will be given priority placement in Clinic A)

This application is for riding at the (select one) level in the above clinic

I will accept placement in the other clinic if I cannot be placed in my first choice: 

I want to audit the clinic if not selected to ride and understand I will be notified:  

The Horse Owner or the Horse Rider is an ATA Member?

Highest level completed by Rider over the last 5 years:
BN N P I A 1* 2* 3* 4*
 
Highest level the Horse has ever completed:
BN N P I A 1* 2* 3* 4*

Please briefly explain why you want to ride this horse in this clinic:

Rider Information:

Rider Name: Date of Birth:

Phone: Cell: eMail Address:

Address: City: State/Province: Zip:

Emergency Contact Name: Emergency Contact Phone/Cell Number:

Horse Information:

Horse’s Registered Name: ATA Registration # (if registered): Age:

Show Name (if different): Breed:   

Sire: Dam: DamSire:

Breeder: Horse Owner's Name: State/Province:

Height: Sex:      

AUDITOR APPLICATION

Name: Phone: Cell:

Address:
City: State/Province: Zip:

ATA Member? Yes

eMail Address:

Registering to attend the ATA convention:   


Directions for Filling out the Form & Notes:

*Applications for riding must be received NOT Later than Oct 3.

**ATA CONVENTION ATTENDEES AUDITING THE CLINIC MUST FULLY COMPLETE AND SUBMIT THE APPLICATION TO ENSURE ADMITTANCE

Not all riders applying will be selected to ride. Selections of riders by the organizer and instructor are final. All applications must be submitted online. Riders are permitted to submit applications for different horses in different classes. If a rider/horse combination is selected for a class, no substitutions will be accepted without organizer’s prior written approval. You will be notified when selections are made, at which time a stabling reservation form with information about the facility, directions, and an invoice for payment will be forwarded to you. Payment for both the clinic and stabling ($35 per night) will be due NLT Oct 3rd. Non-receipt of required payment will result in clinic cancellation. 

If you, as either a rider or auditor applicant, cannot be placed in your choice of Clinic A or B, you will be contacted to see if the other clinic is acceptable for placement.  If a rider applicant cannot be placed in a clinic, you will be contacted to determine if you wish to audit a clinic.

Required releases for admission to a clinic will be provided in the packet of information you will receive with clinic acceptance. Each rider (and owner/trainer/agent, if applicable) must agree to and sign a waiver of liability for the ATA, TIEC and the clinician, and agree to and sign release allowing the use of video and photographs of rider and horse. This clinic will be open to the public for auditing, and may be broadcast or recorded for playing at a later date.

All auditor registration will be paid for from an ATA emailed invoice - in the same manner and by the same date as riders.

For any questions about the clinic, contact Anissa Cottongim at 850-814-0027 or acottongim@yahoo.com

NOTE: Each rider must provide a negative Coggins and current Health Certificate upon arrival at TIEC.

 

Clinic/Audit Fee (ATA will Invoice)

Clinic
Auditor Free if an ATA Member with Full Registration to Convention
$45 if not an ATA Member

 

 


DON’T FORGET YOU WILL NEED TO COMPLETE THE STABLING FORM AND PROVIDE A CURRENT COGGINS TEST AND VETERINARY HEALTH CERTIFICATE ON ARRIVAL

REMEMBER TO COMPLETE, SIGN AND SEND BACK YOUR REQUIRED WAIVER DOCUMENTS.

it will bring information up for you to review on the next page and ask you to Confirm and Submit
- NOTE: YOU MUST HIT SUBMIT on next page to complete registration

 

 

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