WITCH DANCE 35/55 and Fun Ride                                                      SANCTIONED BY: AERC AND SERA

Natchez Trace National Scenic Trail                                                                 AERC AND SERA ARE EQUAL

Houston, Mississippi                                                                                                     OPPORTUNITY GROUPS

April 29, 2006                                                                                                                                                                 

Rider's Name                                                                                         Rider's AERC#                                               

Address                                                                      City                                        State                Zip                                    

E-mail                                                                                            Telephone                                                               

Horse's Name                                   Color                            Breed                    Registration #                                

Horse's AERC #                                                Age            Sex            Owner                                                          

For Junior Riders (under 16: Sponsor's Name                                                                                                              

JUNIOR RIDERS ARE REQUIRED TO BE 8 YEARS OLD AND MUST WEAR HELMETS.

First time rider Yes                No                        AERC Member: Yes            No               

Emergency Contact:                                                                                                                                                    

Weight Division:    HEAVY            MIDDLE            LIGHT            FEATHER            JUNIOR                

MUST HAVE NEGATIVE 1-YEAR COGGINS TO ENTER CAMPGROUND AND RIDE.

Fun Ride                                                                 $20.00  $                    NO DISCOUNT

35 Mile Ride Adult (8:00 a.m. start)                    $55.00  $                   

35 Mile Ride Junior (8:00 a.m. start)                   $35.00  $                   

55 Mile Ride Adult (7:00 a.m. start)                    $80.00  $                   

55 Mile Ride Adult (7:00 a.m. start)                    $55.00  $                   

Non-AERC Member fee for 35, 55 Miles           $15.00  $                   

Camping Fee (per trailer; per night)                    $10.00  $                   

Extra Meals (rider meal included in entry)         $  5.00  $                   (served Saturday afternoon)

EARLY ENTRY DISCOUNT                                $10.00  $                    If postmarked prior to April 15, 2006

TOTAL                                                                                $                   

MAKE CHECKS PAYABLE TO RAYMOND ROWLAND, 20496 HWY. 47, PRAIRIE, MS 39756

FOR OTHER RIDE/CAMPING INFORMATION, CONTACT RAYMOND BY PHONE AT EITHER 662-456-3854 OR 662-456-2538 OR E-MAIL rowlandhardware@bellsouth.net

AS A PARTICIPANT IN THE WITCH DANCE RIDE, I AGREE TO ABIDE BY THE RULES OF AERC, SERA AND THE WITCH DANCE RIDE.  I UNDERSTAND THAT ENDURANCE RIDING INVOLVES BEING IN REMOTE AREAS FOR EXTENDED PERIODS OF TIME, FAR FROM COMMUNICATION, TRANSPORTATION AND MEDICAL FACILITIES, THAT THESE AREAS HAVE MANY NATURAL AND MAN-MADE HAZARDS WHICH RIDE MANAGEMENT CANNOT ANTICIPATE, IDENTIFY, MODIFY OR ELIMINATE; THAT HORSES CAN BE EXCITABLE, DIFFICULT TO CONTROL AND UNPREDICTABLE; AND THAT ACCIDENTS CAN HAPPEN TO ANYONE AT ANY TIME.  I AGREE TO TAKE FULL RESPONSIBILITY FOR MYSELF AND THE ANIMAL I AM RIDING AND FOR MYSELF.  I WILL HOLD THE RIDE MANAGEMENT, ALL RIDE PERSONNEL, AND ALL PROPERTY OWNERS OVER WHOSE LAND THE RIDE COVERS, BLAMELESS FOR ANY ACCIDENT, INJURY OR LOSS AND FREE FROM ALL LIABILITY OF SUCH INJURY OR LOSS THAT MAY OCCUR DUE TO MY PARTICIPATION IN THE RIDE.  I HAVE READ AND UNDERSTAND THIS LIABILITY RELEASE.

Rider Signature                                                                                                      Date                                                                          

Junior's Parent/Guardian                                                                                      Date                                             

Horse Owner's Signature                                                                                     Date