Competitive Fun Day or Driving
July 6th, Sunday
at
Richard Loeb's Farm
N 2346 County Rd J
Lodi,Wi

                                                                 Pre Registration Form:                                

    Name:  

    Address:

    City:   State:Zip:

    Phone:  Cell Phone:  

    E-Mail:
    Horse's Name,if applicable:
    Horse's height in inches at withers:

         MDDA Member entry Fee. . . . .  . . . . . . . . . . . $15  ___________
         Non Member fee . . . . . . . . . . . . . . . . . . . . . . . .$20  ___________
         Entry day of event . . . . . . . . . . . . . . . . . . . . . . . $25

         Grounds/Trailer fee. . . . . . . . . . . . . . . . . . . . . . . $5 ____________

         Outdoor Stall - optional . . . . . . . . . . . . . . . . . . .$5 ____________

MDDA Annual Membership
$10 single, $15 family                                                        ____________
Make check to MDDA and return to 
Wes Licht, 2964 County AB, McFarland, WI 53558

************************************************************************************************************************

READ THIS CAREFULLY BEFORE SIGNING

I wish to participate in the above-named event. In participating I fully understand and recognize the risks and dangers involved, as well as the fact that significant unanticipated, uncontrollable and unexpected risks may arise during the event. I recognize the event management cannot eliminate or control all potential hazards to me or my horse(s) or act to guarantee our safety. I agree to abide by the rules of MDDA. I know and understand that this horse related activity is an inherently dangerous sporting event and agree to assume the complete risk of injury or damage which I or my horse(s) might sustain in competing in this event. As a result, I agree to indemnify and hold harmless the event management, event landowners, participants and agents from and against all loss or damage, including property loss, suffered during or in connection with the loss resulted directly or indirectly from negligent acts or omissions of the event management, event landowners, veterinarians, MDDA, their directors, officers, committee members or agents.

I
HAVE READ AND UNDERSTAND THIS RELEASE.

Driver’s Signature ___________________________________________________ Date ________________
As parent and /or legal guardian of the above-named junior driver, for and in consideration of this child’'s participation in this event, I agree to the terms above-stated as well on behalf of myself, my family and this child, and will hold harmless anyone so consenting.

I HAVE READ AND UNDERSTAND THIS RELEASE.

Parent’s Signature _________________________________________________________ Date ________________

I have agree to groom-navigate for the above named driver and understand this release.


Groom-Navigator’s Signature _________________________________________________ Date ________________