USEA Convention Program

U.S. EVENTING ASSOCIATION MEMBERSHIP APPLICATION HMembership valid from December 1 through November 30 of each year. Explanation of membership categories below. Complete this form and mail to the USEA or register online at https://services.useventing.com. Please use the fields below to update your information. USEA, Inc. • 525 Old Waterford Road NW, Leesburg, VA 20176 Phone: (703) 779-0440 • Fax: (703) 779-0550 • E-mail: memberservices@useventing.com • Web: https://services.useventing.com Print Name: Date of Birth: (Required for USEA Year-End Awards) Address: USEA Area (See back for details): City: State: Zip: ❑ Male ❑ Female E-mail: Daytime Phone: Are you a member of? ❑ USEF Member #: ❑ USET Foundation ❑ USPC Rating: I would like to make a donation to the USEA to support its educational programs and ensure the future of the sport of Eventing. I understand the USEA is a 501(c)(3) educa- tional organization and all donations* are fully tax deductible. *Donations are not considered restricted donations but USEA will make every attempt to honor your intent. ❑ Life Member: Non-transferable. $1,500.00 ❑ Full Member: $85.00 Young Riders must state birthdate. (YR Area Declaration must be received by March 15) ❑ Collegiate Program Member: $60.00 ($25 discount) with verification of participating USEA Affiliate College/University. TO RECEIVE THE DISCOUNT: Your Team Coach/Team Advisor must provide a roster of the Eventing Team members to the USEA. Print Name of College/University: ❑ Junior Member: Age 18 and under. $60.00 Open to all competitors through the end of the calendar year of their 18 th birthday. ❑ Supporting Member: Not allowed to compete with this level. $40.00 ❑ Partial Year Membership: Valid only Oct. 1 - Nov. 30 of each year. $25.00 To receive this discount you MUST join the coming membership year as well. ❑ USEA Inc. (Equine Welfare and Safety, and Educational Programs) ❑ USEA Foundation Please check all that apply: ❑ Instructor ❑ Event Organizer ❑ Farrier ❑ Horse Breeder ❑ Trainer ❑ Veterinarian ❑ Volunteer ❑ Check here if you would like additional information on the USEA Instructors' Certification Program (ICP). ❑ Canada/Mexico Add $35.00 for postage ❑ All other Add $47.00 for postage ❑ USEA Medical Armband Holder & Card: $10.00 ❑ USEA Print Omnibus: $12.00 each (includes postage) Check the issue(s) you want to purchase: ❑ Winter/Spring (Jan. 1 - May 31) ❑ Summer (Jun. 1 - Aug. 31) ❑ Fall (Sept. 1 - Nov. 30) ❑ U.S. Equestrian Federation Rules for Eventing: $10.00 (includes postage) FOR YOUNG RIDERS AGE 21 AND BELOW Please provide emergency contact: Legal Guardian: Relationship: Emergency #: E-mail: ❑ Do not send me Eventing USA magazine. ❑ Do not include my name on third party non-USEA related mailing lists. ❑ Do not send me Member Thank You and USEA Decal. USEF Rules for Eventing Appendix 3, Section 4.4: AMATEUR RIDER (AR) - The following may participate in Eventing competitions as an Amateur. A) Any competitor in possession of a valid Amateur Card issued by the USEF, or B) Any Senior USEA member who competes in the Training, Novice or Beginner Novice level who meets the requirements of Federation GR1306. Individuals declaring such status must present, upon demand, an audited financial statement in support of the claim of eligibility; failure to do so will be deemed a violation. Misrepresentation of eligibility under this provision will subject an individual to disciplinary action under GR1307.6, GR1307.8, GR1308.3 and Chapter 6. Amateur certification under this provision is valid for Eventing competi- tions only and does not confer Amateur status for participation in any other Breed or Discipline. I hereby declare that I am NOT professional, but I am eligible for Amateur status under the conditions set forth in the above USEF rule. NAME: (please print) SIGNATURE: This document serves as the affidavit for your Amateur Status Eligibility. NOTE: A person's Amateur status must be declared for each competition season. To be eligible for the USEA Year-End Awards, this section must be completed and signed. Please be sure to include Amateur status on entry forms. $ $ ❑ Adult Rider Program Member: $25.00 Must hold at least a Supporting Membership to participate in this program. ❑ Young Rider Program Member: $50.00 For Modified level and below. ❑ Young Rider Program Member: $75.00 For Preliminary level and above. 2. MEMBERSHIP CATEGORIES (All members receive Eventing USA magazine.) 4. AREA PROGRAM FEES USEA membership required to participate in ALL Area Programs. 6. ADDITIONAL ITEMS FOR PURCHASE 5. MEMBERSHIP CHOICES PAYMENT: (TOTAL OF 1, OR 2, 3, 4, 6, AND 7) Do not send cash. $ Card #: Exp. Date: C V code #: Billing Zip Code: Signature: Print name on Card: 3. FOREIGN USEA FULL/SUPPORTING MEMBERSHIPS 1. MEMBERSHIP RENEWAL ❑ Auto Renewal My USEA #: 7. PLEASE SUPPORT THE USEA PROGRAMS 8. IMPORTANT INFORMATION FOR ALL MEMBERS 9. AMATEUR RIDER DECLARATION (AGE 19 AND OLDER) ❑ Check Enclosed (Payable to USEA Inc. in U.S. funds only) Charge my: ❑ Visa ❑ MasterCard ❑ AmEx AMATEUR STATUS: For all returning USEA members, Amateur status will be automatically transferred each year. It is the responsibility of each competitor to inform the USEA of any changes to their status. The benefits of amateur status are not retroactive. Amateur status begins at the time it is declared to the end of the current competition season. A fine of $50.00 will be assessed for all Amateur exemption petitions to the USEA. PLEASE READ – USEF DEFINITION OF AMATEUR STATUS

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