1. Please enter member contact information:

   First Name
   Last Name
   Title
   Organization
   Street Address
   Address2
   City
   State/Province
   Zip/Postal Code
   Country
   Work Phone
   Home Phone
   FAX
   E-mail

Please enter Name/Address of Premises Owner to be included as additional insured

Event Dates   Open    Close     (mm/dd/yy)

Estimated Daily Attendance:  Entries      Spectators      Seating Capacity 

Location of show grounds or special event activity:

Have you had a liability claim in the last three years?    Yes No

Are alcoholic beverages served at event?    Yes No

 EVENT CALCULATION:             (Do not include setup and dismantling days)             Membership No.  AEA -

 Total Event Days   X  Daily Rate   + Membership $25.00 =  Amount Due $

I/We hereby make application for association membership and participation sanctioning for the event(s) shown above.  Enclosed is payment for dues, insurance and sanctioning with the American Equestrian Alliance. I/We agree to abide by its rules, regulations and bylaws.  Membership begins January 1, or application and acceptance date if later and expires on December 31, of current year.

 NOTE:  Injury to hunt, rodeo, racing, vaulting, polo or rodeo type event participants is not covered.

Complete as early as possible prior to opening date of show.   I/We agree that, if this application is sent to you by facsimile or other electronic means, you may act upon it whether or not you receive an original hard copy.  I  authorize you  to charge the amount of