This competition will be run under RDA(NSW) Dressage and Equestrian Australia Para Equestrian Rules and Conditions of Entry.

Size: px
Start display at page:

Download "This competition will be run under RDA(NSW) Dressage and Equestrian Australia Para Equestrian Rules and Conditions of Entry."

Transcription

1 06 STATE DRESSAGE CHAMPIONSHIPS & GYMKHANA GALA RIDING FOR THE DISABLED ASSOCIATION NSW Friday th, Saturday 3 th and Sunday 4 th August, 06 Sydney International Equestrian Centre, Saxony Road, Horsley Park 75. This competition will be run under RDA(NSW) Dressage and Equestrian Australia Para Equestrian Rules and Conditions of Entry. FEI Para Equestrian Dressage Tests 03 & specified EA National Tests DRESSAGE CHAMPIONSHIPS & GYMKHANA GALA ENTRY FORM Entries close: 6 July 06 Enquiries: Nicole King on dressage@rdansw.org.au Website: go to Dressage Link Postal address for entries RDA NSW Dressage Sub Committee State Dressage Championships PO BOX 70 SYDNEY MARKETS NSW 9 These Championships are being conducted with support from: Sydney International Equestrian Centre NSW Department of Sport and Recreation OPPORTUNITIES TO SPONSOR THIS EVENT ARE OPEN Enquiries: Nicole King Page of 7

2 RDA(NSW) STATE DRESSAGE CHAMPIONSHIPS & GYMHKANA GALA 06 To be completed and returned no later than 6 th July 06 to: RDA(NSW) Dressage Sub Committee, State Dressage Championships, PO BOX 70, Sydney Markets, NSW 9 RIDERS ENTRY FORM Incomplete entries will not be accepted NAME DATE OF BIRTH (if under 8 years of age) ADDRESS TELEPHONE NUMBER (H and M) ADDRESS GRADE Please circle please circle a b II III IV SECTION please circle A B C D DISABILITY PARA-EQUESTRIAN (formerly IPEC) PROFILE NUMBER classified riders must state Do you require a Mounting Ramp or Block? Please circle Wheelchair Ramp Block Nil Will you be attending the Friday PM Sound check? Please circle YES NO Do you agree that any image taken of the named participant taking part in this event may be used to further the objects of RDA (NSW) generally and this event. YES NO HORSE NAME SUBSTITUTE HORSE NAME see Conditions of Entry Rule 8. NAME OF NOMINATED WARM-UP PERSON For Grades a, b and and Profile 39 Section C only & Walk & Trot Gymkhana Competitors Membership Category: Member of RDA(NSW) Centre: Centre name: PCANSW Member: Club Name: Interstate RDA Rider : Centre name: RDA(NSW) Associate Rider It is expected that all competitors assist the organisers of the event with tasks such as set up & packing up of equipment, pencilling, stewarding arenas and ensuring the venue is kept clean & tidy. I agree for the above-named participant to be allowed emergency medical treatment, if necessary, whilst taking part in any RDA (NSW) activity. I understand that no liability can be accepted by RDA (NSW) or Centre concerned In the event of an injury or accident occurring. Equestrian activities (including but not limited to recreational and therapeutic riding) can be inherently dangerous. I understand that horses can act in a sudden and unpredictable way, especially if frightened or hurt. Accidents can happen in equestrian activities which may result in injury or death to participants. I have voluntarily read and understand this warning and acknowledge and assume the risk in equestrian activities (including but not limited to recreational & therapeutic riding).note: Agreement to this does not affect people s rights under common law. I have read the Conditions of Entry and General Information and fully understand them. I agree to abide by the Conditions of Entry and rules and regulations as set down for the conduct of this event. Rider (if over 8) or Parent/Guardian Signature Date: Page of 7

3 NAME: RIDERS PROFILE FOR COMMENTARY Suggested information: - Age - When did you start riding - Interests outside of Equestrian activities - Who is your favourite sporting person? - The name of your coach - Is there anyone you would like to thank for supporting your riding? - What would you like to achieve with your riding? RIDER/GUARDIAN SIGNATURE Page 3 of 7

4 RIDERS ENTRY CHOICES RIDER NAME: HORSE NAME: DRESSAGE CHAMPIONSHIP RIDERS SECTION A, B, C GRADE a, b, II,III,IV Please tick the tests you will be entering Preliminary Test Championship Test Freestyle DRESSAGE INTRODUCTORY TEST RIDERS SECTION D GRADE a, b, II,III,IV Name of test GYMKHANA COMPETITORS Showjumping Led / Unled G F E D C B Le Trec Led / Unled Walk Trot Canter Prix Caprilli Led / Unled Walk Trot Canter ENTRY FEES: Dressage Championship per rider and horse $0.00 Dressage Introductory Test Full Gymkhana Gymkhana Single Event Dressage Champs & Full Gymkhana 06 Interstate Rider fee Test only at Dressage Championships Per rider and horse combination Showjumping, Prix Caprilli, TREC event only - specify event above Per horse and rider TOTAL $ Coach Declaration (RDA Centre / PCA(NSW Riders): I declare the rider has entered in the appropriate level of competition. The entry choices above are correct and training towards completing these events has commenced. Name: Sign: Unclassified Associate Rider Declaration: I declare this is an appropriate level of competition based on Open competition experience. Sign: Page 4 of 7

5 ACCOMMODATION Please note: Limited cabins are available and will be allocated on a first come first serve basis. Accommodation: (please circle days required) Cabins - twin share Specify nights Thurs, Fri, Sat, Sun $38.00 per night Wheelchair access essential Yes No $ *Camping Specify nights Thurs, Fri, Sat, Sun $.00 per night per site $ *Power Site for float / recharging scooters Specify nights Thurs, Fri, Sat Sun *SIEC charges PER Electrical lead plugged in. $ $.00 per night per site TOTAL $ CABINS FOR HIRE: Basic cabins with single beds, hanging wardrobe, table, chair and wall mounted strip heater. Must provide own linen and pillows. No cooking allowed access to Rider s retreat available. CARAVANS FOR HIRE: Parravans (0) , Potts Caravans (0) , Great Escape Caravan Hire (Castlereagh) , Great Western Caravan Rentals (Castle Hill) , Claron Caravans , Dolphin Caravan Hire (Londonderry) (0) Please make sure you obtain your site number and advise the caravan company before delivery of your van. RIDERS RETREAT: Will be available for all competitors throughout the competition. Full kitchen facilities are available including fridge and freezers, BBQ, Stove, Oven, Microwave and Toaster. It is an expectation that these facilities are kept clean and tidy at all times. Please bring all plates, glasses & cutlery, cooking utensils and equipment. Coffee Cart facilities will be available. Office use only Cabin number Camp area Power site Page 5 of 7

6 Name of Centre or owner of horse: HORSE ACCOMMODATION DETAILS HORSE NAME: SUBSTITUTE HORSE NAME (See Conditions of Entry No. 8) Stallion: YES NO Stallion: YES NO ALL HORSES STABLING OVERNIGHT Name of person staying overnight: MUST HAVE A COMPETENT HANDLER STAYING ON THE GROUNDS. PLEASE COMPLETE ACCOMODATION SECTION Contact Number: Please use one form per horse. If this horse has two competitors complete this page once only. Stabling & Day Stay (please circle days required) Bump In: Arrival no earlier than Thursday th August pm. Bump Out: Departure no later than Sunday 4 th August 4.30pm. (long distance horses may apply to arrive or depart outside of this timeframe) Stabling Specify nights: nights Thurs Fri Sat $3.00 per night Bedding Recommended 5 bales $.50/bale* = Day Stay for horses not requiring stables Specify days: Fri Sat Sun $.00 per horse per day TOTAL * - Cost of bedding is subject to change if done so by SIEC suppliers A separate cheque for bond is to be included. This will be returned/destroyed upon inspection if applicable. Do not include in total. Stabling bond (refundable - see $75.00 per stable Day Stay bond (refundable - see $30.00 per day Return / destroy please circle preference Bedding will be left in each stable unopened. Do not remove bales from other stables. When bales are opened the plastic wrap is to thrown into the waste bin not the manure bin. It is suggested that you or your centre bring a wheelbarrow, rake & broom. This will ensure that you get out early as SIEC can only lend out a certain amount of these items. All bedding must be picked up and placed in bins provided. Riders are responsible to ensure they leave stables clean and tidy. Your bond will be returned only if upon inspection the area is deemed acceptable by a SIEC representative and the Dressage Secretary. Horses may only be tied to floats connected to cars in the designated day parking area. TACK ROOM Only complete if a Private Tack room is required. Private Tack room Required by - Centre or name: Tack Room see $40.00 whole event Required Y / N Office use only Stable number Day Stay Nights required Tack Room Page 6 of 7

7 Summary Sheet Rider: Entry from Page 4 $ Horse Accommodation - Stables Horse $3 night $.50/bale Horse Accommodation Stables - $ Horse Accommodation - Day Stay Horse Day $/horse/day 3 4 Horse Accommodation Day Stay - $ Private Tack Room non refundable Number required Tack $40 each (whole event) Tack Room non refundable - $ Name Horse Accommodation $38/night $/night Power $/night Accommodation - $ Horse Accommodation Cleaning Bond - refundable Stable Bond $75 Day Stay Bond $30/day Horse Accommodation Bond Refundable - $ Grand : Circle: Direct Deposit: Date Money Order Cheque Cheque or money order made payable to RDA NSW Dressage (cash not accepted) Direct Deposit: Westpac BSB: A/C: Please use reference: Surname Dressage when direct depositing and stateoffice@rdansw.org.au to advise the date and amount. $ Horse Accommodation Cleaning Bond Refundable: If Bond is paid by direct deposit please provide return account details. Acct: BSB: Name: Cheque/Money order or Direct deposit Page 7 of 7

2014 TOTAL WIMPS ODE

2014 TOTAL WIMPS ODE TARC PROUDLY PRESENT THE 2014 TOTAL WIMPS ODE Equestrian Park Curtin Sunday 26 th October, 2014 TARC is pleased to present our annual One Day Event for the less confident rider (aka The Wimps). There will

More information

Scone & District School Horse Sports Presented By Scone Grammar School

Scone & District School Horse Sports Presented By Scone Grammar School Scone & District School Horse Sports Presented By Scone Grammar School Tuesday 14 June 2016 White Park, Guernsey Street, Scone 8.00 am Gear Check 8.30 am Start Entries Closed How to enter the Scone & District

More information

CHRISTIAN VENUES ASSOCIATION ABN : 74 050 611 295

CHRISTIAN VENUES ASSOCIATION ABN : 74 050 611 295 CHRISTIAN VENUES ASSOCIATION ABN : 74 050 611 295 National Office PO Box 5552 South Windsor, NSW 2756 Phone: (02) 45 87 7155 Facsimile (02) 4587 7933 Email: info@christianvenues.org.au WEB : www.christianvenues.org.au

More information

The Hope House 25 th Street Little Rock, AR 72204 501-351-5164***501-565-HOPE. Name DOB AGE SSN: DL# Current Address: Phone #: Sobriety Date:

The Hope House 25 th Street Little Rock, AR 72204 501-351-5164***501-565-HOPE. Name DOB AGE SSN: DL# Current Address: Phone #: Sobriety Date: The Hope House 25 th Street Little Rock, AR 72204 501-351-5164***501-565-HOPE Name DOB AGE SSN: DL# Current Address: Phone #: Sobriety Date: Employer name Phone #: Position Supervisor Emergency contact:

More information

Go for 2&5 DRYANDRA TETRATHLON 2016 Hosted by the Dryandra Pony Club

Go for 2&5 DRYANDRA TETRATHLON 2016 Hosted by the Dryandra Pony Club Go for 2&5 DRYANDRA TETRATHLON 2016 Hosted by the Dryandra Pony Club Saturday 27th & Sunday 28th February 2016 Dryandra Regional Equestrian Park Darcy Street, Cuballing WA The TETRATHLON consists of four

More information

CONTENTS. Contact Details 2

CONTENTS. Contact Details 2 ENTRY GUIDE CONTENTS Contact Details 2 1 1. Entries 3 1.1 Eligibility Criteria & Qualifications 3 1.2 Wild Card Applications & Entries 4 1.3 Key Entry Dates 5 1.4 Late Entries 5 1.5 Acceptance & Refusal

More information

Dear equestrian friends,

Dear equestrian friends, Dear equestrian friends, we wish to invite your disabled riders to the first international event which we will hold in Italy from the 23rd to the 26th of July in Casorate Sempione, near Milan. We will

More information

Lochside Clubhouse Reservation Form

Lochside Clubhouse Reservation Form Please Print Lochside Clubhouse Reservation Form Date of Event *2 week notice is preferred, certain holiday periods may be blocked. Name _ Address Telephone (H) (W) Email Purpose of Function _ Capacity

More information

Brandon Light Horse & Pony Society Inc. Spring Schooling Show

Brandon Light Horse & Pony Society Inc. Spring Schooling Show Brandon Light Horse & Pony Society Inc. Spring Schooling Show Keystone Centre Brandon, MB Westoba Agricultural Centre of Excellence Arena February 16 & 17, 2013 General Information Judge: Jane Haglund

More information

Munstead. DRESSAGE Combined Training Versatile TREC

Munstead. DRESSAGE Combined Training Versatile TREC Munstead DRESSAGE Combined Training Versatile TREC also incorporating BRC Combined Training Qualifier SUNDAY 4th MARCH 2012 at Heath Farm, Heath Lane, Godalming, Surrey GU7 1UN www.munsteadhorsetrials.com

More information

BSPA SHOWING CLASSES AT THE CABIN

BSPA SHOWING CLASSES AT THE CABIN BSPA SHOWING CLASSES AT THE CABIN UALIFIERS FOR THE ROYAL INTERNATIONAL HORSE SHOW 2014 AND WORLD CHAMPIONSHIPS OF COLOUR 2014 ( BSPA MEMBERS WITH REGISTERED HORSES ONLY IN RIHS CLASSES 11-12) OPEN TO

More information

ST MARYS RUGBY LEAGUE CLUB EMPLOYMENT APPLICATION

ST MARYS RUGBY LEAGUE CLUB EMPLOYMENT APPLICATION ST MARYS RUGBY LEAGUE CLUB EMPLOYMENT APPLICATION St Marys Rugby League Club Limited Cnr Forrester & Boronia Roads St Marys NSW 2760 PO BOX 8097 Werrington County NSW 2747 Phone: 9677 7777 Fax: 9833 1725

More information

RESIDENTIAL BOOKING FORM

RESIDENTIAL BOOKING FORM Email RESIDENTIAL BOOKING FORM Arrival/Departure Dates Estimated Arrival/Departure Time Group Numbers Arrival Date: Arrival Time: am/pm Male: Departure Date: Departure Time*: am/pm Female: *Please note

More information

Horse Lover s Management Corporation Reach 11 Recreation Area Arizona Horse Lover s Park Facility Use Agreement

Horse Lover s Management Corporation Reach 11 Recreation Area Arizona Horse Lover s Park Facility Use Agreement THIS AGREEMENT made and entered into this day of, 20, by and between HORSE LOVER S MANAGEMENT CORPORATION hereinafter called HLMC and hereinafter called User. The Equestrian Program Coordinator, hereinafter

More information

Serviced Office Hire. Page 1 of 12

Serviced Office Hire. Page 1 of 12 Serviced Office Hire Page 1 of 12 Table of Contents OUR FACILITIES... 3 SERVICED OFFICE:... 3 MEETING ROOM:... 3 WHERE ARE WE?... 4 Hire Fees... 4 SERVICED OFFICE... 5 FACILITY SPECIFICATION... 5 Additional

More information

EAST NEW MARKET VOL. FIRE DEPT., INC.

EAST NEW MARKET VOL. FIRE DEPT., INC. East New Market Volunteer Fire Department Inc. Agreement for Use of the Banquet Hall THIS RENTAL AGREEMENT ( Agreement ) is made by and between the East New Market Volunteer Fire Department Inc. (hereinafter

More information

Open Horse Show April 23 & 24, 2016

Open Horse Show April 23 & 24, 2016 Iowa Equestrian Center - Kirkwood Community College - Cedar Rapids Two Single Shows - Single Judged - Show Twice! Judges Announced Soon! Pick Your Show Fee: $8.00 per class Saturday and Sunday $55 - All

More information

2016 VENDOR APPLICATION Can Am Equine Marketing Inc. RETURN BY FAX TO BILL BROWN AT: 519-740-7199 20 DAWSON ROAD GLEN MORRIS N0B 1W0

2016 VENDOR APPLICATION Can Am Equine Marketing Inc. RETURN BY FAX TO BILL BROWN AT: 519-740-7199 20 DAWSON ROAD GLEN MORRIS N0B 1W0 2016 VENDOR APPLICATION Can Am Equine Marketing Inc. RETURN BY FAX TO BILL BROWN AT: 519-740-7199 20 DAWSON ROAD GLEN MORRIS N0B 1W0 ALL BREED EQUINE EXPO, APRIL 1-3, 2016 MARKHAM, ONTARIO COMPANY NAME:

More information

GUIDELINES FOR CDN SHOWS

GUIDELINES FOR CDN SHOWS GUIDELINES FOR CDN SHOWS At least 6 months before show: 1. Prepare budget and draw up proposal for potential sponsors 2. Clear judges to be used with DSA Judges Official 3. Provisionally book Judges 4.

More information

HORSE RIDING SURREY LTD LIVERY PRICES D.I.Y GRASS LIVERY. Cost - 100 per calendar month. Includes. Use of facilities excluding stable. D.I.Y.

HORSE RIDING SURREY LTD LIVERY PRICES D.I.Y GRASS LIVERY. Cost - 100 per calendar month. Includes. Use of facilities excluding stable. D.I.Y. HORSE RIDING SURREY LTD LIVERY PRICES D.I.Y GRASS LIVERY Cost - 100 per calendar month Use of facilities excluding stable. D.I.Y. LIVERY Use of facilities including stable. Feeding A.M Cost - 130 per calendar

More information

One Day Show Bill ~ Thursday, July 9th, 2014, 8:00 a.m. Location: Red River Valley Fairgrounds Check-in Opens at 7:00 a.m.

One Day Show Bill ~ Thursday, July 9th, 2014, 8:00 a.m. Location: Red River Valley Fairgrounds Check-in Opens at 7:00 a.m. One Day Show Bill ~ Thursday, July 9th, 2014, 8:00 a.m. Location: Red River Valley Fairgrounds Check-in Opens at 7:00 a.m. Judge: Laurie Holverson Dressage test Pre-entries must be postmarked on or before

More information

Registered SLSA Compliance Program manufacturers will be provided with a discounted rate to display their products (see below).

Registered SLSA Compliance Program manufacturers will be provided with a discounted rate to display their products (see below). Circular Title: Australian Surf Life Saving Championships 2015 Manufacturer and Competition Equipment Displays Document ID: 71/14-15 Department: Capacity and Capability Sport Audience: SLSA Compliance

More information

National Driving Trials & National Novice Qualifier Catton Park Catton Park, Derbyshire, DE12 8LN 6-8 May 2016

National Driving Trials & National Novice Qualifier Catton Park Catton Park, Derbyshire, DE12 8LN 6-8 May 2016 National Driving Trials & National Novice Qualifier Catton Park Catton Park, Derbyshire, DE12 8LN 6-8 May 2016 By kind permission of Mr & Mrs Robin Neilson Competition classes: Novice Horse Novice Pony

More information

AYR HOLIDAY HOMES 2016 TARIFF AYR TOURING PARK 2016 TARIFF

AYR HOLIDAY HOMES 2016 TARIFF AYR TOURING PARK 2016 TARIFF AYR HOLIDAY HOMES 2016 TARIFF PRICES SHOWN ARE PER UNIT PER WEEK, NOT PER PERSON AND INCLUDE VAT, ELECTRICITY, GAS AND BED LINEN. Ayr Terrace Flats Apartments Meor Minster Carbis Gwidden Sleeping 5 5 4

More information

Vacation Without Limits Page 1 of 18

Vacation Without Limits Page 1 of 18 Vacation Without Limits Page 1 of 18 Introduction Imagine a holiday spot where families with special needs are fully accommodated: ramps and lifts where they are needed, doorways that work, and lots of

More information

$138 $138. ($125 + $13 shavings) $138

$138 $138. ($125 + $13 shavings) $138 UF/IFAS Okeechobee County 4-H Program in conjunction with Children s Services Council of Okeechobee County Presents: 2013 Just Horsing Around Day Camp $125/Week + $13 shavings fee Youth must be 8 years

More information

Student House Australia Rules and Procedures

Student House Australia Rules and Procedures Student House Australia Rules and Procedures 1. Student House Australia Student Agreement. 2. Student House Rules 3. Health and Safety. Smoke Detectors. Fire Extinguisher. Fire blanket. Fire Evacuation

More information

EXCURSION Policy & Procedures Next review date: Currently under review

EXCURSION Policy & Procedures Next review date: Currently under review Last reviewed: August 2013 EXCURSION Policy & Procedures Next review date: Currently under review By: Dean of Curriculum Acknowledgement: The following policy and procedures are derived from and follow

More information

June 12-14 th 2015 Golden Spike Events Center Rodeo Arena 1000 N. 1200 W.Ogden Utah

June 12-14 th 2015 Golden Spike Events Center Rodeo Arena 1000 N. 1200 W.Ogden Utah June 12-14 th 2015 Golden Spike Events Center Rodeo Arena 1000 N. 1200 W.Ogden Utah DASH FOR DOLLARS OPEN $20,000 ADDED & AVERAGE AWARDS 18/40 $2000 ADDED & AVERAGE AWARDS 2D FUTURITY $5000 ADDED & AVERAGE

More information

WRITTEN PARTICULARS (DOMESTIC WORKER)

WRITTEN PARTICULARS (DOMESTIC WORKER) WRITTEN PARTICULARS (DOMESTIC WORKER) Given by: (herein after referred to as "the employer") Address of employer:. to (herein after referred to as "the employee") 1. Commencement Employment will begin

More information

PERSONAL INJURY CLAIM FORM

PERSONAL INJURY CLAIM FORM V-INSURANCE GROUP Corporate Authorised Representative of Willis Office use only Policy Number: 0028785 Claim Number: PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR ATHLETICS AUSTRALIA V-Insurance Group

More information

Acat World Championship 2016 18-24 June. IJsselmeer off Medemblik (the Netherlands) PROVISIONAL NOTICE OF RACE

Acat World Championship 2016 18-24 June. IJsselmeer off Medemblik (the Netherlands) PROVISIONAL NOTICE OF RACE Acat World Championship 2016 18-24 June IJsselmeer off Medemblik (the Netherlands) Organized by the Royal Yachtclub Hollandia (RYH), in conjunction with the Dutch A-Division Catamaran Class Association

More information

The Robert Clark Horticultural Centre Meeting Room

The Robert Clark Horticultural Centre Meeting Room The Robert Clark Horticultural Centre Meeting Room External Booking Application Form NAME/GROUP:.. CONTACT PERSON (if corporate booking):. ADDRESS:... PHONE NO: MOBILE:.. PHONE NO. OF PERSON RESPONSIBLE

More information

TTouch 4 You and Your Horse Happy Dog Ranch, Littleton, CO May 29-31, 2015. Instructor: Linda Tellington-Jones

TTouch 4 You and Your Horse Happy Dog Ranch, Littleton, CO May 29-31, 2015. Instructor: Linda Tellington-Jones TTouch 4 You and Your Horse Happy Dog Ranch, Littleton, CO May 29-31, 2015 Instructor: Linda Tellington-Jones Training location: Happy Dog Ranch Bernadette Spillane 7811 West Titan Rd Littleton, CO 80125

More information

Rover Scout Motorsport Western Australia

Rover Scout Motorsport Western Australia Bush Baja 2015 Northam, WA. Rover Scout Motorsport Western Australia Event Entry Form Khanacross/Motorkhana Event Date: 29/5/15 1/6/15 Khanacross to be held under the International Sporting Code of the

More information

2015 Membership Application Form

2015 Membership Application Form Please read all information carefully Eligibility Applicants must reside within the State of Queensland. Age Categories Queensland Weightlifting Association Inc. Affiliated with the Australian Weightlifting

More information

maximum prices applied

maximum prices applied Happy Village Roma Village Pricing Pricelist 2015 maximum applied Price per person per night including: shuttle bus from and to the station, swimming pool for adults and children, bed-linen, final cleaning,

More information

The following have been invited to officiate:

The following have been invited to officiate: Interscholastic Equestrian Association Point Show #HB3054 November 21, 2015 Randolph College Riding Center 4762 Hawkins Mill Rd, Lynchburg, VA 24503 434.661.8068 Zone 3 Region 6 Priority ***QUALIFICATION

More information

BICYCLE NEW SOUTH WALES PERSONAL INJURY CLAIM FORM

BICYCLE NEW SOUTH WALES PERSONAL INJURY CLAIM FORM Office use only Policy Number: AN A044041 PAD Claim Number: BICYCLE NEW SOUTH WALES PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR BICYCLE NEW SOUTH WALES INC V-Insurance Group Pty Ltd V-Insurance Group

More information

Noosa Jazz Festival Terms and Conditions Food and Market Stalls

Noosa Jazz Festival Terms and Conditions Food and Market Stalls Noosa Jazz Festival Terms and Conditions Food and Market Stalls Welcome to the Noosa Jazz Festival! As Noosa Shire s second longest-running event, the Noosa Jazz Festival has a proven track record of delivering

More information

City of Edinburgh Running Festival YOUTH (9 16 yrs) ENTRY FORM BORDERS ATHLETICS 2016 YOUTH ENTRY BOOKLET

City of Edinburgh Running Festival YOUTH (9 16 yrs) ENTRY FORM BORDERS ATHLETICS 2016 YOUTH ENTRY BOOKLET BORDERS ATHLETICS 2016 YOUTH ENTRY BOOKLET Youths are 9 16 years old at 1 st June 2016. 16 year olds at 1 st June 2016 can opt to run as either Adult or Youth, this is a one off choice. IF AFTER DECLARING

More information

at Messecenter Herning on 6-9 March, 2014 for

at Messecenter Herning on 6-9 March, 2014 for DanskVarmblod s NationalStalionShow 2014 at Messecenter Herning on 6-9 March, 2014 CONDITIONS for Material& RegularClasses indressageandjumping TheclassesareopentostalionsselectedtoDanskVarmblod andtoespecialyinvitedcompetitors.forfurtherdetails,

More information

PERSONAL INJURY CLAIM FORM

PERSONAL INJURY CLAIM FORM Office use only Policy Number: AN A043307 PAD Claim Number: ATHLETICS AUSTRALIA PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR ATHLETICS AUSTRALIA V-Insurance Group Pty Ltd Authorised Representative No.

More information

Wenhaston Village Hall Application for Hire Revised 31/05/2011

Wenhaston Village Hall Application for Hire Revised 31/05/2011 Wenhaston Village Hall Application for Hire Revised 31/05/2011 Event... Date of Event... Time of Event: from...am/pm to...am/pm Hours... Setting-Up Time: from...am/pm to...am/pm Entertainment provided

More information

NOTICE OF RACE. Europe Class Open Week July 3rd to July 7 th & International Europe Class World Championship July 7th to July 14th

NOTICE OF RACE. Europe Class Open Week July 3rd to July 7 th & International Europe Class World Championship July 7th to July 14th NOTICE OF RACE Europe Class Open Week July 3rd to July 7 th & International Europe Class World Championship July 7th to July 14th The Organizing Authority: Circolo Vela Torbole Tel. +39 0464 506240 Fax

More information

How To Live In New York City Hall

How To Live In New York City Hall www.rennert.com ACCOMMODATIONS IN NYC YMCA /VANDERBILT Economy Student Residence Walking distance to school Single rooms Double rooms (for 2 students arriving together, except during summer months June

More information

New WKF proposed rules to be trialled at these championships!

New WKF proposed rules to be trialled at these championships! New WKF proposed rules to be trialled at these championships! 5-6 February 2011 Venue: SYDNEY Australia Categories: WKF Kata and Kumite categories & Children 9-13 Years Referees: Seminar: All referees

More information

Meeting Room Hire Information Helen's Place, Middle Swan

Meeting Room Hire Information Helen's Place, Middle Swan Meeting Room Hire Information Helen's Place, Middle Swan 41a Great Northern Highway, Middle Swan (access via rear 12 Leslie Road) T: (08) 6274 3700 F: (08) 9250 1624 E: contact@risenetwork.com.au Contact

More information

PERSONAL INJURY CLAIM FORM

PERSONAL INJURY CLAIM FORM Office use only Policy Number: ANA042769PAD Claim Number: BICYCLE QUEENSLAND PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR BICYCLE QUEENSLAND; V-Insurance Group Pty Ltd Authorised Representative No.

More information

October 8 th & 9 th. Featuring. Special Guest Grand Master Scott Seo (8 th Dan) from South Korea

October 8 th & 9 th. Featuring. Special Guest Grand Master Scott Seo (8 th Dan) from South Korea October 8 th & 9 th Featuring Special Guest Grand Master Scott Seo (8 th Dan) from South Korea Saturday October 8 th - 1 st Oceania Cup Hapkido Competition at the Upper Hutt Cosmopolitan Club Sunday October

More information

Frequently asked Questions

Frequently asked Questions Who is Spectrum Housing Group? Frequently asked Questions Spectrum Housing Group is a Registered Social Landlord (Housing Association) registered with the Industrial and Provident Society and the Housing

More information

The weekend schedule features classes for AMHA Miniature Horses Family Fun!!! Great Competition!!!

The weekend schedule features classes for AMHA Miniature Horses Family Fun!!! Great Competition!!! The Minnesota Miniature Horse Club Proudly presents their July Show Judges Renee Bush, Minnesota judging AMHA Portia Kalinka, Wisconsin Senior Judge AMHA Jon Wolf, Illinois Senior Judge AMHA Dean Duxbury,

More information

THIS CHECKLIST SHOULD BE CARRIED OUT BY EACH CLUB ON A MONTHLY BASIS.

THIS CHECKLIST SHOULD BE CARRIED OUT BY EACH CLUB ON A MONTHLY BASIS. FACILITY INSPECTION CHECKLIST THIS CHECKLIST SHOULD BE CARRIED OUT BY EACH CLUB ON A MONTHLY BASIS. BUILDING ACTION FOLLOW -UP YES NO Entry/Exit 1. Clearly lit 2. Disabled access provided 3. Stairs - clear

More information

EQUINE CANADA/NCCP ENGLISH COMPETITION COACH SPECIALIST

EQUINE CANADA/NCCP ENGLISH COMPETITION COACH SPECIALIST EQUINE CANADA/NCCP ENGLISH COMPETITION COACH SPECIALIST CANDIDATE YEARLY TRAINING PLAN PACKAGE (Evaluation OF Outcome #4: Design an Equestrian Sport Program) PLEASE PREPARE YOUR TRAINING PLAN SUBMISSION

More information

This form to be used per background definition below for casual & regular hire up to 1 year

This form to be used per background definition below for casual & regular hire up to 1 year This form to be used per background definition below for casual & regular hire up to 1 year This LICENSE AGREEMENT is between and The Owner/Operator On behalf of Girl Guides NSW & ACT (Licensor) District

More information

Allianz Win a trip to Italy!

Allianz Win a trip to Italy! Allianz Win a trip to Italy! 1. Information on how to enter the Promotion forms part of these Terms and Conditions. Participation in this Promotion is deemed acceptance of these Terms and Conditions. 2.

More information

District Address: Address: PO Box 950, Strawberry Hills NSW 2012

District Address: Address: PO Box 950, Strawberry Hills NSW 2012 This form to be used per background definition below for casual & regular hire up to 1 year LICENSE AGREEMENT is between and Reserve Trust No: R (power to lease under s102 Crown Lands Act 1989) District

More information

LSU RISK ASSESSMENT FORM AU FORM D

LSU RISK ASSESSMENT FORM AU FORM D Club Date of Risk Assessment Updated 21.11.11 Author Ann Wilson/Dave Crawford Proposed Review Date Location/Event/Activity TRIPS/TOURS/TRAINING WEEKENDS Driving to and from venues (minibuses/van) Please

More information

Education and Training Unit. Orientation Training Courses (OTC)

Education and Training Unit. Orientation Training Courses (OTC) Education and Training Unit Orientation Training Courses (OTC) Courses for Overseas Dental Graduates 2016 ADDITIONAL EXPERIENCE SESSIONS MOCK EXAM OTC MOCK EXAM 2016 In 2016 OTC is able to offer a two-

More information

SPORTING ACCIDENT CLAIM FORM Please read this page first before completing the Claim Form

SPORTING ACCIDENT CLAIM FORM Please read this page first before completing the Claim Form SPORTING ACCIDENT CLAIM FORM Please read this page first before completing the Claim Form Dear Member, Thank you for your Claim Form request. This letter contains important information relevant to your

More information

Terms and Conditions. This is a Full Service Contract

Terms and Conditions. This is a Full Service Contract Sunrise Event Center Rental Agreement This is a Rental Agreement between Sunrise Event Center (Herein after known as Sunrise Event Center or Facility) and (Herein after known as CLIENT) for the use of

More information

Explanation. Overseas Hire Expatriate Teacher. Overseas Hire Expatriate Teacher

Explanation. Overseas Hire Expatriate Teacher. Overseas Hire Expatriate Teacher Faculty and Staff Benefits - Effective for all Employment Agreements beginning August 1, 2015 The benefits that will apply to you will depend on which category of contract you have with ISU. Not all benefits

More information

2015/16 SUPER SERIES LEVEL 1 LONG COURSE OPEN MEET

2015/16 SUPER SERIES LEVEL 1 LONG COURSE OPEN MEET & Present their 2015/16 SUPER SERIES LEVEL 1 LONG COURSE OPEN MEET (Under ASA Laws and Regulations and Technical Rules of Racing) License 1SW160152 Within the Summer Meets Qualification Window 22 nd /

More information

Tenancy Application Form

Tenancy Application Form 10/601 Anzac Highway, GLENELG NORTH SA 5045 Postal Address: PO Box 453 GLENELG, SA 5045 Tenancy Application Form Office: (08) 8376 3335 Facsimile: (08) 8376 7986 Website: www.eliterentals.com.au E-mail:

More information

2. For cancellation or amendment of travel arrangements due to you or your relatives illness /death (Complete Sections A, C D and E)

2. For cancellation or amendment of travel arrangements due to you or your relatives illness /death (Complete Sections A, C D and E) IMPORTANT: please read this before you start Use the check list below to help you complete your claims form, and identify you will need to attach. We don t want you to miss something. Delays can occur

More information

CAMPING CASA DI CACCIA

CAMPING CASA DI CACCIA A. RECEPTION B. TV G. BAR - RESTAURANT - PIZZERIA C. MEDICAL ROOM E. NEWSPAPERS H. COLD SHOWERS ROULOTTE TENT AND CAMPER D. SERVICES FOR HANDICAP J. WE AND SHOWERS K. ANIMATION ACTIVITY MOBILE HOMES GENERAL

More information

BLACK HORSE RUN PROPERTY OWNERS ASSOCIATION BARNS AND TRAILS (Homeowner s Barn Lease Agreement)

BLACK HORSE RUN PROPERTY OWNERS ASSOCIATION BARNS AND TRAILS (Homeowner s Barn Lease Agreement) BLACK HORSE RUN PROPERTY OWNERS ASSOCIATION BARNS AND TRAILS (Homeowner s Barn Lease Agreement) THIS LEASE AGREEMENT is made and entered into as of this day, 2012, by and between, a resident of Black Horse

More information

Thank you. 5 Steps to Success

Thank you. 5 Steps to Success Page 1 of 11 Thank you Thank you for becoming a host for the Leukaemia Foundation s World s Greatest Shave, one of Australia s biggest fundraising events that is also loads of fun for everyone! This guide

More information

When you make a holiday rental booking using Wotusee.com the following terms and conditions apply.

When you make a holiday rental booking using Wotusee.com the following terms and conditions apply. When you make a holiday rental booking using Wotusee.com the following terms and conditions apply. You must be 18 years and over to book holiday rental displayed on Wotusee.com. 1) Supplier goods and services

More information

MAJOR EVENT APPlication

MAJOR EVENT APPlication City of Victor Harbor MAJOR EVENT APPlication NAME OF THE EVENT Location of Event: Applicant s Name: Organisation (if applicable) Postal Address: Phone, Fax, E-mail and Mobile: Website Address (if applicable)

More information

Information sheet for exchange students

Information sheet for exchange students Information sheet for exchange students Dear student, Here s some information about the apartments Stubor can offer exchange students. First of all, it is International Relations Office at Linnaeus University

More information

2016 CIA Examination Application Form For Australian Candidates only

2016 CIA Examination Application Form For Australian Candidates only 2016 CIA Examination Application Form For Australian Candidates only Personal Details Membership ID First Name Last Name Name as it appears on Photo ID Home Address Position Organisation Date of Birth

More information

LASZLO S CLASSICAL APARTMENT RENTAL AGREEMENT

LASZLO S CLASSICAL APARTMENT RENTAL AGREEMENT LASZLO S CLASSICAL APARTMENT RENTAL AGREEMENT This agreement ( The Agreement ) is made by and between Laszlo s Classical Apartment ( Homeowner ) and ( Guests ) as of the date last set forth on the signature

More information

DRESSAGE SA CHALLENGE (PREVIOUSLY KNOWN AS THE SANEF COMPETITION)

DRESSAGE SA CHALLENGE (PREVIOUSLY KNOWN AS THE SANEF COMPETITION) WITH THE WESTERN CAPE DRESSAGE COMMITTEE PRESENTS THE CDN GRADED WC LEG OF THE DRESSAGE SA CHALLENGE (PREVIOUSLY KNOWN AS THE SANEF COMPETITION) Together with graded warm-up classes, qualifying classes,

More information

2013 NEW JERSEY SKI & SNOWBOARD COUNCIL Quebec City & Winter Carnival, Canada Trip Wednesday, January 30- Tuesday, February 5

2013 NEW JERSEY SKI & SNOWBOARD COUNCIL Quebec City & Winter Carnival, Canada Trip Wednesday, January 30- Tuesday, February 5 2013 NEW JERSEY SKI & SNOWBOARD COUNCIL Quebec City & Winter Carnival, Canada Trip Wednesday, January 30- Tuesday, February 5 FAIRMONT LE CHÂTEAU FRONTENAC: STANDARD ROOM-1 OR 2 BEDS, INCLUDES TAXES, BAGGAGE

More information

2016 FLORISSANT SUMMER PLAYGROUND INFORMATION AND POLICIES

2016 FLORISSANT SUMMER PLAYGROUND INFORMATION AND POLICIES 2016 FLORISSANT SUMMER PLAYGROUND INFORMATION AND POLICIES CAMP LOCATIONS CAMP DATES/TIMES June 6 July 15, 2016 James J. Eagan Center (300) 9:00am 3:00pm Koch Park (320) No camp July 4th All Prices Subject

More information

CRIMINAL LAWYERS ASSOCIATION OF THE NORTHERN TERRITORY. Criminal Justice Diagnosis Terminal

CRIMINAL LAWYERS ASSOCIATION OF THE NORTHERN TERRITORY. Criminal Justice Diagnosis Terminal CRIMINAL LAWYERS ASSOCIATION OF THE NTHERN TERRITY Criminal Justice Diagnosis Terminal 12 th Biennial Conference SATURDAY 27 TH JUNE FRIDAY 3 rd JULY 2009 BALI HYATT HOTEL, SANUR BEACH BALI Registration

More information

Durham Caribbean Festival BOOTH APPLICATION & TERMS OF PARTICIPATION Saturday, June 25, 2016 10:00 A.M. 9:00 P.M. 416-876-4679

Durham Caribbean Festival BOOTH APPLICATION & TERMS OF PARTICIPATION Saturday, June 25, 2016 10:00 A.M. 9:00 P.M. 416-876-4679 BOOTH APPLICATION & TERMS OF PARTICIPATION APPLICANT Business/Org. Name: Name of Booth: Contact Person: Mailing Address: Telephone Daytime: Mobile: Nighttime: Fax: Email: Only the products of the said

More information

PERSONAL INJURY CLAIM FORM

PERSONAL INJURY CLAIM FORM Office use only Policy Number: Claim Number: 01PO527349 PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR V-Insurance Group Pty Ltd Authorised Representative No. 432898 an authorised representative of Willis

More information

PERSONAL INJURY CLAIM FORM

PERSONAL INJURY CLAIM FORM Willis Australia Limited ABN: 90 000 321 237 AFS License Number 240600 Office use only Policy Number: SUA/002395 Claim Number:. TABLE TENNIS AUSTRALIA PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR TABLE

More information

UNIVERSITY OF HOUSTON

UNIVERSITY OF HOUSTON JAMES DICKEY'S UNIVERSITY OF HOUSTON 2014 MEN'S BASKETBALL CAMPS CAMP FEATURES Expert instruction from Houston Basketball staff and student-athletes Outstanding lectures Grouping of all players by ages

More information

MELBOURNE UNIVERSITY TENNIS CLUB

MELBOURNE UNIVERSITY TENNIS CLUB MELBOURNE UNIVERSITY TENNIS CLUB KEY ORIENTATION DATES THURSDAY 27 MARCH Club Sign-up Day, South Lawn Grading Session #1* SUNDAY 2 MARCH Grading Session #2* THURSDAY 6 MARCH Club Sign-up Day, North Court

More information

(Full amounts must accompany registration checks will be cashed on April 1 to allow time for processing note earlier date).

(Full amounts must accompany registration checks will be cashed on April 1 to allow time for processing note earlier date). REGISTRATION INFORMATION 2016 CENTRAL AREA 4-H HORSE CAMP DATES: June 2-5, 2016 Thursday 11:00 a.m. thru Sunday 4 p.m. LOCATION: Camp Shamineau (between Lincoln and Motley, 2 miles E of Hwy 10) ELIGIBILITY:

More information

Transport Schemes in Poole

Transport Schemes in Poole Transport Schemes in Poole Information collated by Poole Well being Collaborative January 2014 1. Poole Community Transport Services: a. Dial a Bus b. Voluntary driver scheme c. Concessionary travel 2.

More information

FACULTES UNIVERSITAIRES SAINT-LOUIS Service social Service logement Boulevard du Jardin botanique 43

FACULTES UNIVERSITAIRES SAINT-LOUIS Service social Service logement Boulevard du Jardin botanique 43 FACULTES UNIVERSITAIRES SAINT-LOUIS Service social Service logement Boulevard du Jardin botanique 43 Information about accommodation for the Incoming students Three houses have been made available to the

More information

Claim Form TRAVEL INSURANCE

Claim Form TRAVEL INSURANCE ACCIDENT & HEALTH INTERNATIONAL Claim Form TRAVEL INSURANCE Sydney Level 4, 33 York Street Sydney NSW 2000 GPO Box 4213, Sydney, NSW, 2001 T: +61 2 9251 8700 F: +61 2 9252 4385 ABN: 26 053 335 952 AFS

More information

Expiry Date. If you have selected Cheque please nominate payee

Expiry Date. If you have selected Cheque please nominate payee TRAVEL INSURANCE CLAIM FORM IMPORTANT: PLEASE READ BEFORE YOU COMPLETE THIS FORM 1. Please answer all questions and provide all relevant documentation to avoid delays with your We are unable to process

More information

Q. Please can you confirm if the members policy offers 3rd party liability for all the ponies we own or just or the child members main pony?

Q. Please can you confirm if the members policy offers 3rd party liability for all the ponies we own or just or the child members main pony? Q. What cover do Branches receive? A. The District Commissioner, Committee and Officials, volunteers and instructors are insured for Public and Products Liability up to 30,000,000 for any one claim in

More information

A1 Motor home Hire & Rental Terms & Conditions

A1 Motor home Hire & Rental Terms & Conditions 1: GENERAL A1 Motor home Hire & Rental Terms & Conditions PLEASE READ CAREFULLY Collecting and Returning the Motor Home A helpful hint: If possible try not to start your holiday on the same day you collect

More information

MEETINGS. Application for Hire

MEETINGS. Application for Hire MEETINGS Application for Hire HIRING INFORMATION ACON s Meeting Centre at 414 Elizabeth Street, Surry Hills has a range of multi-purpose meeting rooms that are made available to groups and organisations

More information

INVITATION. To All Member Associations 24.11.2010

INVITATION. To All Member Associations 24.11.2010 INVITATION To All Member Associations 24.11.2010 Dear Member Associates, On behalf of the Organizing Committee of the Turkish Archery Federation (TAF) we kindly would like to invite you to take part in

More information

THE ROTARY CLUB OF EAST KILBRIDE KITTOCH KITTOCH CHARITY CLASSIC CAR TOUR 2016

THE ROTARY CLUB OF EAST KILBRIDE KITTOCH KITTOCH CHARITY CLASSIC CAR TOUR 2016 THE ROTARY CLUB OF EAST KILBRIDE KITTOCH KITTOCH CHARITY CLASSIC CAR TOUR 2016 SATURDAY 10 th September 2016 Welcome to the Rotary Club of East Kilbride Kittoch s seventh Classic Car Tour, sponsored by

More information

THE MISSOURI GRAND PRIX

THE MISSOURI GRAND PRIX Information Amended 12/29/09 Meet: The 2010 Missouri Long Course Grand Prix at the University of Missouri Dates: February 12-15, 2010 Sanction: MV 10 11 TT Sanction: MV 10 12TT Venue: University of Missouri

More information

YOUR HOLIDAY RENTALS GUIDE

YOUR HOLIDAY RENTALS GUIDE YOUR HOLIDAY RENTALS GUIDE Section 1 CHOOSING TO LIST YOUR PROPERTY AS A HOLIDAY RENTAL Whether you own your property primarily as an investment or as somewhere to spend your holidays, listing it as a

More information

STUDIO 56 MAURITSSTRAAT

STUDIO 56 MAURITSSTRAAT STUDIO 56 MAURITSSTRAAT 138 private studios & two room apartments for (international) students! located in the heart of Eindhoven At only 1.1 km from Eindhoven Central Station! At only 1.6 km from TU/e,

More information

Bowling Holidays at Sunset Beach Club

Bowling Holidays at Sunset Beach Club at Sunset Beach Club If you enjoy bowling, and also like holidays in the sun, then why not combine the two at Sunset Beach Club?! We can organize rink rental and competitions at the local Benalmadena Bowls

More information

Australian Ideal College

Australian Ideal College This PDF file contains information on: Home > Living in Sydney > Money Matters Currency, Exchanging Money and Traveller s Cheques Page 1 Currency Exchange Rates Page 2 Banks, Banking Hours and Business

More information

For all claims the following documents must be sent to us along with this claim form:

For all claims the following documents must be sent to us along with this claim form: IMPORTANT: please read this before you start Use the check list below to help you complete your claims form, and identify documents you will need to attach. We don t want you to miss something. Delays

More information

Break O Day Council. Facilities Hire Agreement Form. Break O Day Council Facilities Hire Agreement Sports Complex/Foreshore 1

Break O Day Council. Facilities Hire Agreement Form. Break O Day Council Facilities Hire Agreement Sports Complex/Foreshore 1 Break O Day Council Facilities Hire Agreement Form Break O Day Council Facilities Hire Agreement Sports Complex/Foreshore 1 Hirer Details Hirer Name/Organisation: Contact Person: Postal Address: Phone

More information

NE Horse Training Contract 1/6 TRAINING CONTRACT

NE Horse Training Contract 1/6 TRAINING CONTRACT NE Horse Training Contract 1/6 TRAINING CONTRACT WITNESS THIS AGREEMENT this day of, 20, by and between, hereinafter referred to as Trainer and, hereinafter referred to as Owner, and if Owner is a minor,

More information