JUNIOR Yes No

Owyhee 100/80/60/30 ENTRY FORM

Rider Number (management use)

Read and sign the rider release of liability!!

Rider: AERC# _______ Name_________________________________________

Address: ____________________________________________________________

Phone: _________________ Email: _____________________________________

AERC Division: Feather Light Middle Heavy Junior

Horse: AERC#________ Age_____ Name__________________________________

_

Horse Owner Name/Address _______________________________________________

Entry Fee: 100 Miles: ......$120.00 (Pre-Register) ......$140.00 (NOT Pre-Reg.) ____________

Entry Fee: 80 Miles: ........$100.00 (Pre-Register) .......$120.00 (NOT Pre-Reg.) ____________

Entry Fee: 60 Miles: .........$80.00 (Pre-Register) .......$100.00 (NOT Pre-Reg.) ____________

Entry Fee: 30 Miles: .........$60.00 (Pre-Register) .......$80.00 (NOT Pre-Reg.) ____________

All AERC entries include Friday night dinner.

Extra Friday Dinner tickets:………………………………... $10.00 ____________

Corral pen: $10 (entire weekend ) ………………….….......$10.00 ____________

Total …………. _______________

Checks (payable to Steph Teeter) or Credit Card _____ _____ _____ _____ ___/___

For Pre-Registration discount, entries must be received by May 1.

Mail or fax entry to: Steph Teeter 15401 Bates Creek Rd Oreana, ID 83650

For more info: steph@endurance.net phone: 208 834 2788 - fax: 209 755 8107 www.endurance.net/oreana/owyhee100

RELEASE For all Participants of the Owyhee 100 Endurance Ride

I, _________________________________________________________(print full name here), wish to enter and participate in the Owyhee 100 Endurance Ride, to be held May 7, 2005 and I have read the rules, conditions, and regulations of the event and will comply with them. As a participant in the event, I agree to abide by the rules of all sanctioning organizations, including AERC, US and the aforementioned ride.

I agree that my participation in the ride involves certain inherent risks, which include, but are not limited to, the following: (1) horseback riding involves being in remote areas for extended periods of time, far from communications, transportation, and medical facilities, that these areas can have many natural and man-made hazards which ride management cannot anticipate, identify, modify, or eliminate, these hazardous surfaces/subsurface conditions including such things as rocks, trees, puddles, streams, fences, jumps and/or other hard objects and /or holes, divots, ledges which could cause an equine to trip and /or fall and /or could strike a participant who falls from or is thrown from an equine; (2) that horses can behave in unpredictable ways which can result in accidents to anyone at any time, resulting in injury, severe injury, or death; (3) that an equine's reactions to sound, movements, objects, vehicles, persons, animals, scents, or insects cannot be predicted. I agree to take full responsibility for myself/my child or children, and the animal(s) I/my child or children is/are riding or have in camp. I will hold harmless the AERC, its officers and all individual members there of, Bureau of Land Management-USDI, employees of such, John and Steph Teeter, all ride personnel, and all property owners over whose land the ride crosses, their representatives, successors and assigns, for any accident, injury or loss that might occur due to my participation in this ride, and free all liability for such injury or loss, including that due to negligence not caused by wanton or willful misconduct of the Owyhee 100 organizers and management.

I hereby certify that my horse is not under the influence of medication and will not be treated with or given any medications prohibited by AERC rules. I also hereby give permission to AERC or its duly appointed agent to take any appropriate action deemed necessary to check for possible administration of drugs to my hose. The undersigned verifies acceptance of risks and responsibilities for rider's and horses' conditions and certifies that all information on this form is correct to the best of his/her knowledge.

Rider __________________________________________________

Horse Owner ____________________________________________

Parent/Guardian of under 18 Rider _______________________________

Date: ____/____, 2005