Name of Horse :                                                                                   

Registered ACHR N°  :     

Owners name :                
                                                              

Identification Number :    

I authorize  :
 
 Mrs. Mr. Miss.  

 Name. :          

 First name :  

Address  :    

Identification N° : 

Leasers Signature :

Leaser, from date to date   

to sign all association documents concerning the above named horse for the above period.

Owners Signature :