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2011 OPL ENTRY FORMDRESSAGE COMPETITIONSOFFICIAL USECOMPETITIONDueNameDuplicate copies of Entry Form. One horse per Entry Form.Non compete horse must complete entry. Signatures required.Mail or Email to (Entry) Secretary. Form Date: March 23, 2011DateEntry Complete eDoB (JrYR)EMailStatusPhoneCitizenshipTRAINEREmergency ContactEMailPHONETIC(Name / Phone)For Breed Show In Hand indicate Handler as Rider If unknown indicate Owner Status: Open / JrYR / AAPronunciation of difficult name(s)Previous NameHORSEBreed / Reg #SexHeightCogginsColorSireSire Breed / Reg #Owner of SireDamDam Breed / Reg #Owner of DamDam's SireCountry BirthYear BirthFor SaleBreederCoggins is required Include Breed Papers with Entry Form for eligibility for Breed Specific Special Awards Indicate USA as Country Birth for eligibility for Breed Show Born in America cash awardUSEF / USDF MEMBERSHIP NUMBERS / FEESRIDERNUMBEROWNEROR NON MEM FEENUMBERTRAINEROR NON MEM FEENUMBERCOACH ON GROUNDSOR NON MEM FEEUSEF 30 30 30USDF 25 25Not RequiredNUMBEROR NON MEM FEEHORSENUMBER 30OR NON MEM FEEReq only forQual & Ch classes 25Not RequiredInclude copy of all USEF / USDF membership cards or pay one Non Member Fee per person per show Pay 5 USDF Affidavit Fee for each missing copy of USDF Rider / Owner / Horse membership cardMissing cardMissing cardMissing cardNot RequiredNot RequiredUSDF 5 5 5AffidavitAffidavitAffidavitFEI FIELDSFEI Rider #MISCELLANEOUS FEESFEI Horse #FEI Passport #CDI Competitors must indicate Rider Citizenship above, fill out these three FEI fields, and pay 35 IHP FeeCLASS ENTRY FEESNUMBERDESCRIPTIONENTRY FEEADDITIONAL FEEPost EntryClass ChangeNon CompeteNon NEDARV / CamperPaddockCDI IHP 35Other FeeOther FeeFULL PAYMENT MUST BE INCLUDED WITH ENTRYTotal USEF / USDF FeesTotal Class Entry FeesTotal Miscellaneous FeesTotal Stall and Shavings Fees (not including Stall Deposit)OFFICE FEE(See Prize List)DRUG FEE 15(CDI 23)( 15 Drugs/Meds / 8 USEF)( 7 Drugs/Meda / 8 USEF)FORM TOTALNotesAdditional Fee for 10 USDF Qualifying Fee / NEDA 50 Sweepstakes Fee etc.STABLING DETAILS FOR HORSE ON THIS ENTRY FORMStabling GroupRiderLodging / PhoneHorse StallHorse NameTack StallMonTuesWedTOTAL PAIDArrive (Day / Time)Depart (Day / Time)ThursHorse SexNotesTack Stall must be for same nights as Horse Stall Pay Stall Deposit(s) with separate checkFriSatSun# StallsFee per StallStall FeesShavings# BagsFee per BagShavings FeesStall Deposit# StallsFee per StallStall DepositPROCEED TO MANDATORY SIGNATURES, CREDIT CARD PAYMENT & PREVIOUS SCORES

Form Date: March 23, 2011USDF ClauseI hereby agree to release, indemnify and hold harmless USDF, its instructors, officers, directors, agents and volunteers from and against any and all loss,liability or damage arising from or because of, or in connection with, participation in this competition or related activities. I hereby agree to release, indemnifyand hold harmless the show management, show committee and members, officers, directors, agents and volunteers from and against any and all loss, liabilityor damage arising from or because of, or in connection with, participation in this competition or related activities.Massachusetts ClauseUnder Massachusetts law, any equine professional is not liable for injury to, or the death of, a participant in equine activities resulting from the inherent risks ofequine activities, pursuant to section 2D of Chapter 128 of the General Laws.USEF Membership StatementLife, senior active and junior active members shall be eligible to participate in all classes at Regular Competitions, Eventing Competitions at thePreliminary Level or above and Combined Driving Competitions at the Advanced Level, Dressage, Reining, and Vaulting Competitions andEndurance Rides. A non-member may participate as a handler, rider, driver, owner, lessee, agent, coach or trainer at Regular Competitions,Eventing Competitions, Dressage Competitions, Reining Competitions and Combined Driving Competitions upon payment of a 30 non-memberregistration fee. Participants in the following classes are exempted from the Requirements of this rule: 1) leadline; 2) exhibitions; 3) games andraces; 4) classes for 4-H members; 5) walk/trot and academy classes (Academy classes are classes limited to horses used regularly in a lesson program); 6) USDFintroductory level tests, pas de deux and quadrille classes; 7) NRHA Endorsed Reining Competitions; 8) Opportunity classes; 9) citizens of othernations who have proof, in English, of current membership in good standing of their own National Federation; 10) USEA beginner novicedivision, and 11) assistant handlers in Dressage Sport Horse Breeding classes. See GR901.9Federation Entry AgreementBy 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 ofUnited States Equestrian Federation, Inc. (“the Federation”) and the local rules of the competition. I agree to be bound by the Bylaws and Rules of theFederation and the competition. I will accept as final the decision of the Hearing Committee on any question arising under the Rules, and agree to releaseand hold harmless the competition, the Federation, their officials, directors and employees for any action taken under the Rules. I represent that I am eligibleto 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 ofacceptance of entry, the Federation and/or the Competition may use or assign photographs, videos, audios, cable-casts, broadcasts, internet, film, new mediaor 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 theFederation. 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 herebyexpressly and irrevocably waive and release any rights in connection with such use, including any claim to compensation, invasion of privacy, right ofpublicity, or to misappropriation. The construction and application of Federation Rules are governed by the State of New York, and any action institutedagainst the Federation must be filed in New York State. See GR908.4.USEF Release, Assumption of Risk, Waiver and IndemnificationThis document waives important legal rights. Read it carefully before signing.I AGREE in consideration for my participation in the Competition for which this Entry Blank is used to the following:I AGREE that “the Federation” and “Competition” as used herein includes the Licensee and Competition Management, as well as their officials, officers,directors, employees, agents, personnel, volunteers and Federation affiliates.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 dangerousrisks of accident, loss and serious bodily injury including broken bones, head injuries, trauma, pain, suffering, or death (“Harm”).I AGREE to hold harmless and release the Federation and the Competition from all claims for money damages or otherwise for any Harm to me or my horseand for any Harm of any nature caused by me or my horse to others, even if the Harm arises or results, directly or indirectly, from negligence of theFederation or the Competition.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 toclaims 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 FederationRules about protective equipment, including GR801 and, if applicable, EV114, 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 aparent or guardian of a junior exhibitor, I consent to the child's participation and AGREE to all of the above provisions and AGREE to assume all of theobligations of this Release on the child's behalf. I represent that I have the requisite training, coaching and abilities to safely compete in this competition.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 theFederation on the official USEF accident / injury report form.BY SIGNING BELOW, I AGREE to be bound by all applicable Federation Rules and all terms and provisions of this entry blank.SIGNATURESEntry will not be accepted without mandatory signatures, full payment,legible proof of Coggins and other requirements stated in Prize List.SIGNATURES ACKNOWLEDGE ACCEPTANCE OF PRIZE LIST REFUND POLICYRIDER )PARENT / GUARDIAN SIGNATURE SignatureCopies / faxes are acceptable. The word “Same” and ditto marks will be rejected.Trainer is person responsible for condition of horse and must be on grounds during show.Any person on grounds who coaches Rider/Handler must sign this form as Coach.Print NamePrint Name(Required if Rider / Driver / Handler / Vaulter / Longeur is a minorOWNER / AGENTSignaturePrint NameTRAINER Signature(Mandatory)Print NameCOACH Signature(If applicable)Print Name(Mandatory)CREDIT CARD INFORMATION (Check Prize List to be sure this Competition accepts credit card payments NEDA Spring and Fall Shows accept only Mastercard and Visa)Print NameExpirationMastercardVisaNumberof Cardholdermm/yySecurityBilling StreetTown/St/ZipCodeSignatureAmountPREVIOUS COMPETITION SCORES FOR QUALIFICATION / elPct

Opening Date: April 11, 2011 Closing Date: June 18, 2011 Days & Dates: Saturday, July 2, 2011 Official Name: Letter Perfect Farm Dressage Show USEF Recognized Dressage Show Level 1 USEF/USDF# 329242 GAIG/USDF Qualifying Location: Letter Perfect Farm, 130 West St. Uxbridge, Ma 01569 Management: Letter Perfect Farm, Inc. Kelli Mason-President Manager: Kelli Mason