ENTRY FORM: CONES PALOOZA – Saturday, September 2, 2023 Play Pause Unmute Mute Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.In order to register for this event, participants must hold a 2023 Ontario Carriage Driving Association and a Ontario Equestrian membership. Space will be alloted on a “first come; first served” basis with payment. OCDA membership registration forms can be found at www.carriagedriving.ca Are you an current OCDA member?YesNoOntario Equestrian membership numberDriver's Name *FirstLastEmail *PhoneAddressAddress Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryEquine TypeVSEPonyHorseTurnoutSinglePairMultipleName of Equine/Breed/ColourAge of EquineHeight of EquineSex of EquineMareGeldingStallionName of 2nd Equine/Breed/ColourAge of 2nd EquineHeight of 2nd EquineSex of 2nd Equine MareGeldingStallionName of 3rd Equine/Breed/Colour Sex of 3rd EquineMareGeldingStallionAge of 3rd Equine Height of 3rd Equine Name of 4th Equine/Breed/Colour Sex of 4th Equine MareGeldingStallionAge of 4th Equine Height of 4th Equine Rates and feesEntry fee – $50.00Mandatory Medic fee – $10.00Total$0.00Although we encourage people to leave their dogs at home, pets must be contained at competitor’s trailer. Any dogs found roaming will be held and a $50 bail-out fee will be required to release the dog. Special entry fees are available for Youth (under 18 years old) and Para drivers. Please contact Vicki Cork at 519-429-1607 for more details. After Entry Closing Date of August 26, there will be NO REFUND of entries without a Veterinarian Certificate or a Doctor’s note. Signature Clear Signature Do you have any special considerations (e.g. first show, sharing a carriage, time limitations)?How will you be paying? *PayPalE-transferPlease send your etransfer to Treasury@carriagedriving.ca and clearly identify it as payment for Cones Palooza – Saturday, September 2, 2023 PayPal CommercePayPal CheckoutCredit CardCard NumberExpiration DateSecurity CodeCard Holder NameDate Submit