Rider’s day number:    Riders FEI number:     Riders nationality:

Home Club:    Home Club No:   

Distance of Ride:   CEI**120KMS CEI*80KMS NERA 80KMS NERA 50KMS

Rider Detail:

Title:  Mr. Mrs   Initials: Surname:Name called:

Birth Date:   Address:

Town/City: Country:

Tel No: (home)   (cell )   (work)

Blood Group:   Medical Aid & No:     Category:   Senior - Std Weight Senior - Heavyweight Junior/Young Rider Child No Weight

Novice Qualifications:   Person Responsible:            CEI Qualifications:  

Name of Groom 

For Official Use:  Weight of Rider:  Total Weight:

               HORSE INFORMATION:

NERA No:   FEI Passport No:

Name of Horse:   Date of Birth:

Novice Qualifications:             CEI Qualifications:   

Breed of Horse: Arab Other Part Arab Anglo Arab Cross Breed     Colour of Horse: Black Brown Dark Brown White Fox White Grey Other     Gender of the Horse: Mare Gelding Stallion

Markings on head:             Markings on legs:       Recent illness or Vet care:  

 Date of arrival at site:  Outside paddock  Own paddock

I hereby declare that I know and understand the constitution, rules and guidelines of NERA and this specific ride and will adhere to them. By submitting this entry form I undertake that for myself, my heirs, my administrators or any other person that has legal rights after my death, forfeit all legal claims that might occur from any accidents, any harm or damage and claims as a direct or indirect result of any person or animal’s actions and that NERA, any club, all individual members, and any other person will be excluded from any claim or legal action arising as a result of my participation. I accept that every rider or visitor that rides a horse, either his own or another persons, do so on their own risk. I undertake to take the responsibility for all costs arising out of veterinarian assistance to my horse and/or any medical aid to myself and I will pay any such costs. To obtain approval for emergency medical evacuation, contact: . If no emergency evacuation information is provided I hereby authorize the emergency medical team or the event controlling staff to act on my behalf and accept full responsibility for any and all costs so incurred.  

E-Mail Address:  

Entry fees paid:  Yes,  No         Amount:   

Stabling fees paid:  Yes,   No      Amount:  

Payment date:     

By Clicking Submit, I accept the Terms Of Service of this website and I hereby certify that the information provided by myself is correct and true.  I accept that by clicking submit, I have completed a official entry to the Walvisbay 2007 Endurance Ride Championship.  I hereby identify myself with the following official Document, Passport ID Document Birth Certificate Number, . 

For Official Use:     Child rider no:   XXXXX         Linked to Senior Rider no:   XXXXX