For a printable version of this form, click here

Entries need to be returned by May 16, 2009

 

Participant’s Name: _________________________________________

 

Participant’s Address: _______________________________________

 

                        ______________________________________________

 

                        ______________________________________________

 

Phone Number: ____________________________________________

 

Horse’s Name: _____________________________________________

 

Club Name: _______________________________________________

 

Seat:               English                      Western                     Saddle Seat

 

 

Payment: A Check or Money Order, non-refundable deposit of $20.00 needs to accompany your entry form to reserve your place in the clinic.  This is due to the limited number of clinic participants and our desire for a full clinic.  The balance of $20.00 is to be paid at arrival at the clinic.

 

 

Parent or Guardian’s Signature

 

_______________________________________ Date: _________________

 

Return Form To:
Sarah Chadbourne
1233 High Street
W. Gardiner, ME  04345

 

 

 

For more information on educational programs in your area, contact your county Extension office.