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The 2016 USDF/Dover Medal Official Tracking Form

Please print out the form and fax to 978-952-6972


Date of Application

Name of Show
Location
Date of Show
USDF Region #

For the first two (2) wins please complete the top section only. If this is your 3rd win please complete the entire form.


This is my (choose one): USDF/Dover Medal win for Competition Year 2015 (Oct 1, 2015-Sept 30, 2016)

1st Win
2nd Win
3rd Win


(Only items in bold will be used for publication purposes)
Name
Date of Birth
Street
City/Town
State
Zip Code
Telephone
Email
Horse Ridden in this Class
Trainer
Stable
City/Town
State
I attest that at the time of my Dover Medal winning rides I was an adult amateur according to the rules of USEF and a current Group or Participating Member in good standing of USDF.


IF THIS IS YOUR 3RD WIN: COMPLETE BELOW


Tell us about yourself: How long have you been riding? Family, school, career, sports, hobbies, or any other interesting information




Tell us about your horse: Breed, age, previous winnings, etc.




List your hometown newspapers and any regional equestrian publication. Please include address, telephone number and email address where possible; EMAIL PHOTO to mmorin@doversaddlery.com (required)



I give my permission for the above information to be utilized for press releases, media information and for marketing and promotional purposes


If you have any questions, please contact:

Mary Morin, Sponsorship Coordinator
Dover Saddlery, Inc.
Email: mmorin@doversaddlery.com
Fax: (978) 952-6972
Mail: 525 Great Road, Littleton, MA 01460