2023 Intent to Qualify

USPC Southwest Region’s

2023 Intent to Qualify for

USPC Championships West – St. Louis, MO

 

 

This form is due before you compete in a Southwest Regional qualifying rally.

You may send it in with your entry or you may bring it and your fee to the rally check in.

 

I, __________________, member in good standing of the _________________________ Pony Club of the Southwest Region of the USPC, hope to qualify to compete in the 2023 USPC Championships Central in the following disciplines: Check as many as you think apply and mark E or C to note which Champs for each discipline chosen.

                                    

 

 

Quiz	Dressage
Eventing	Show Jumping
Games	Other (Specify)

I understand that if I qualify, I will be eligible to be chosen to be placed on a team that will travel to Championship to represent SW Region. I understand that it is a high honor to be selected for a team to represent Southwest Region at Championships and I will work to uphold the sportsmanship and team spirit of my region.

Enclosed is $50.00 check made out to Southwest Region. This check will be applied towards my portion of the Championships entry fee. The check indicates my serious intent to participate in the Championships. I understand that the $50 is forfeited if I decide not to go to Championships but will be refunded if I do not qualify or qualify but am not selected for the team.

 

Signed _______________________________ Date________________

 

I understand that my child, ___________________, is planning to qualify Championships 2023, in St. Louis, MO. He/she will be responsible for transportation expenses, room and board, horse expenses (if applicable), and the portion of the entry fee not covered by the region or the club. I also understand that each participant at Championships is expected to have a designated adult from the region to act as a volunteer and/or chaperone.

 

Parent’s Signature ______________________ Date_________________