2004 colonel bengt ljungquist - cblm.org
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Level: ____________________________
Percentage: ________________________
Musical FS Level: ______________________
MFS Percentage: ________________________
www.CBLM.org
Rules on www.CBLM.org – your Division maybe changed when you enter the Championships
Date: _____________________
Qualifying Competition Information
Qualification FormQualifying dates: September 22, 2020 - September 19, 2021
Please check www.CBLM.org to verify your qualification status
Only Riders who have NOT qualified will be individually notified
Email or mail this form to me as soon as the show is over, to insure that you qualify - it is YOUR responsibility to mail this form to me!! Submit a copy of the FRONT of your test (with show name/score earned/horse-rider combination) to get your form processed immediately.
You MUST submit a separate Official Show Entry form to the Show Secretary, TBA, or enter
online, to enter the Finals...
Rider Name: _________________________________ Email: __________________________
Jr/Yr Birthdate: _______________ Phone #: ___________________ Rider Division*: A or B (may be changed)
Horse Name: ____________________________________________
Address: _______________________________________________________________
City/State/Zip: ____________________________________________________
2021 Colonel Bengt Ljungquist Memorial Championships October 1- 3, 2021
Signature of GMO President or Membership Chair: ____________________________I Am a Member of GMO:_________________________
* Have the Rider's GMO President or Membership Secretary sign this form below.* Enclose a proof of membership letter signed by the Rider's GMO President or Membership Secretary.* Enclose a copy of the address page of the Rider's local groups' newsletter.and last name or USDF number at https://www.usdf.org/card/* Enclose a copy of the Rider's Group Membership card. You can print any Rider's membership card by searching by first
PROOF OF VALID GMO MEMBERSHIP You must provide proof of GMO (please name it below) membership in ONE of
the following ways:
Bettina Longaker, Qualifying Secretary [email protected] 8246 Open Gate Rd Gordonsville VA 22942 f: 540-301-8166
* Rider Division: Please read the 2021Entry Secretary - TBA Carolina Horse Park Raeford NC
Name of Qualifying Show: ______________________________________