The Goring Hotel

National Team Chase Championship 2004

ENTRY FORM

Contact name:

Address:

Telephone:

Name of Team:

Name of rider:	Name of horse:
Team Captain

All participants must carry Third Party Liability Insurance for not less than £5 million which is available through membership of the Countryside Alliance. It is also strongly recommended that all participants have Personal Accident Insurance.

ENTRY FEE FOR CHAMPIONSHIP CLASS - £76.00 per Team (cheques made payable to Fernie Team Chase)

QUALIFICATION DETAILS: In accordance with the qualification criteria for the 2004 National Championship (detailed on page 2), please indicate where and when your team qualified for this class: Event: ........................................ Class: ........................ Date: .............. The Team Captain hereby declares that the Team entered above fully complies with the qualifying requirements of the Goring Hotel National Team Chase Championships and will abide by its rules at all times. Signed: ...................................................................

Please return the entry form with CHEQUE for £76.00 (payable to Fernie Team Chase) by Saturday 20th March 2004 to the Hon. Secretary:-

Katie Harpham, East Norton Hall, East Norton, Leicestershire LE7 9XD.

Penalty for late entries £10 extra per team.

Team times will be advertised on www.teamchasing.co.uk prior to the event

Please write any items of interest for the use of the commentator on the back of the entry form.