RHASS Ploughing Medal
APPLICATION CONTACT
Name of individual who is completing this form on behalf of the medal recipient
*
Prefix
First Name
Last Name
Email Address (this shall be used to inform you of the application status and delivery of the medal)
*
example@example.com
MEDAL RECIPIENT
Please provide the following information of the individual who shall be receiving the medal
Recipient's Name
*
Prefix
First Names
Last Name
Recipient's Phone Number
*
Please enter a valid phone number.
Recipient's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PLOUGHING SOCIETY/ASSOCIATION
Please provide the following information of the Society/Association Secretary
Name of Society/Association who held the match
*
Name of Society/Association Secretary
Prefix
First Name
Last Name
Address of Secretary
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Society/Association Email Address
*
example@example.com
Society/Association Phone Number
*
Please enter a valid phone number.
DETAILS OF MATCH
Please provide the following information of the match held by the Society/Association
Date of match
*
-
Month
-
Day
Year
Date
Address of where match was held
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Type of match
*
Tractor
Horse
If you have selected "Tractor", please select one of the below
*
2 furrow
3 furrow
4 furrow
N/A
Number of ploughs competing for the medal
*
Area of ground assigned to each plough (in hectares)
*
Time allowed for ploughing (please specify if this includes a break, and for how long)
*
Please provide a copy of the match rules
*
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RHASS MEMBER IN ATTENDANCE OF MATCH
Name
*
Prefix
First Name
Last Name
RHASS Membership Number
*
Date of Birth
*
-
Month
-
Day
Year
Date
PAYMENT
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RHASS Ploughing Medal
£
65.00
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