May 28-30 Red white and Buckle Registration Name CGA Number First Name * Last Name * Address * City * State * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code * Mobile Number * Email * Date of Birth (If Under 18) Mount Name * Division * FCAAAAAAAAA+Qualify Events (In Order) - CGA Members ($8.00) Each) * All 13 events Barrels Poles 1 Speed Barrels Keyhole Big T Birangle Figure 8 Flags Poles 2 Quadrangle Figure 8 Stake Hurry Scurry Single Stake Speed Ball Jackpots ($5 Each) 2 Mystery Jackpots per day 2 Mystery Jackpots per day Grounds Fee ($ 20 per day) * One-Day Grounds Fee One day grounds fee (required) For Ribbon race and Setups use comments to tell us who your ridding with ($10 person.) Also list the Setup events you want * Ribbon Race Setup Comments Release of Liability * The California Gymkhana Association, Inc., and cosponsoring organization, if any, will not be responsible for any accident that may occur to be caused by any equine competing at any show, or for any article of any kind or nature that may be lost or destroyed or in any way damaged. Each competitor will be responsible for any injury that may be occasioned to any person or animal or damage to any property while on the grounds by any equine owned, or in his custody or control, and shall indemnify and hold harmless the California Gymkhana Association, its officials and directors individually and collectively, and cosponsoring organization, clubs, and arena owners, if any, from and against all charges and expenses of every kind and nature whatsoever arising out of or which may be incurred by reason of any accident, injury, or damage to person or property caused by the ownership, competition or custody or control of any animal competition. Presentation of first signed entry form and/or/membership application shall be deemed acceptance of this release throughout the entire show season for any subsequent CGA sanctioned function in which you or your child/children may participate. In signing this release, please bear in mind that gymkhana is a contest of speed, that there is a certain element of danger involved, and that you will be riding at your own risk. CGA REQUIRES that’s its members wear approved safety helmets. If you choose not to wear a safety helmet, then you as an adult rider will accept full responsibility for yourself for any injury which may result from the act when riding in any CGA sanctioned show. EFFECTIVE March 1, 2003 all riders under 18 are required to wear a helmet when riding in a CGA sanctioned show. In addition, I certify that I’m either an Individual or Family Member of the California Gymkhana Association. Signature (Parent if Under 18) - Type Name * Date *
