Jockeys Benefit Association of Canada

On behalf of Daren Gomez the executive director of the Jockey's Benefit Association of Canada (JBAC) we invite you the Jockeys in our association, to complete this form in order to ensure effective communication between the directors and members in all horse racing matters concerning Jockeys in Canada.

* indicates required

Email Address *

First Name *

Last Name *

Address *

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

Mobile / WhatsApp Number *

Date of Birth *

Month / Day

Agent First Name *

Agent Last Name *

Agents Phone Number *

Lowest Riding Weight (lbs)

Height - Feet *

Please enter a number for how tall you are in feet - example I am 5

Height - Inches *

Please enter a number for how tall you are - example in the above question you said you were 5 feet tall so now enter how many inches tall you are - example 5 feet 5 inches tall

I will be primarily racing at (select one)

Jockeys Canada