2010 Event Application 

Please notify the EXCA Office if your event is cancelled.

Submit a separate form for EACH event.

New Event or Change to an existing event: -------Choose One------ New Event Change to an existing event

Event Date:

Event Type: -----Pick from this List------ WPQ Regional Championship

• WPQ (single points/single fees)

• Regional  (quadruple points/single fees)

Number of Days of the event -----Pick a number----- 1 2 3 4 5

Host Club Name:

Host Member Name:

Address:

City/State/Zip:

Contact Information:

• Home Telephone:

• Work Telephone:

• Cell Phone:

• Email:

• EXCA Event Sanctioning Fee: $200.00.  The EXCA Sanctioning fee is paid one time each year.  The fee covers every EXCA Event your Club offers in 2010. Please use a separate Event Application for each event.

  Event Name:

  Location/Arena:

  Event City:

  Event State:

  EXCA Divisions offered: Please Check

  	Young Guns (ages 7-11)
  	Youth (ages 12-17)
  	Non-Pro (ages 18 & over)
  	Pro (ages 18 & over)
  	Ride Smart (age 55 & over)
  	Novice

  Judges One:

  Name:

  Telephone:

  Email:

  ---

  Judge Two:

  Name:

  Telephone:

  Email:

  I have read the EXCA Rulebook and agree to follow all EXCA rules for this event. I understand the requirements of EXCA and agree to comply fully with EXCA requirements.

                                                                                                                            AI Form