Two-Day Immersive Symposium Retreat: October 14-15 2023

Application Form

Two-Day Immersive Symposium Retreat: Mythos Farm of Hopewell, New Jersey
Your Contact Information

So we know where to find you, should we need to reach out and/or send something to you!
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number*

Area CodePhone Number
How did you hear about Dr. Maria?*

YouTubeFriend/TrainerFacebook/Social MediaMagazine InterviewI'm not sure, but I'm on Dr. Maria's email list!Other
About You

Some details to help us understand more about you and your goals for this event.
Do you currently ride?

YesNo
If you ride, please complete the following questions:
Discipline (please select all that apply)*

DressageEventingTrail RidingEndurance RidingEventingHunter/JumperWestern PleasureWestern "Working" DisciplinesOther
Type of Riding*

CompetitivePleasure
How many years have you had your horse? (Or how many years have you been working together?)*
What are your riding goals?*
What are you currently doing to achieve those goals? Do you feel like it is working well for you and your horse?*
What do you think your horse's goals are?*
What are you hoping to take away from this event?*
Media Consent

I do hereby give Maria Katsamanis, and Mythos Farm its assigns, licensees, successors in interest, legal representatives, and heirs the irrevocable right to use my name (or fictional name), picture, image, portrait, or photograph in all forms and in all media and in all manners, without any restriction as to changes or alterations (including but not limited to composite or distorted representations or derivative works made in any medium) for advertising, trade, promotion, exhibition, or any lawful purpose, and I waive the right to compensation in any form or to inspect or approve the photograph(s) or finished versions incorporating the photograph(s), including written copy that may be created and appear in connection therewith.
Media Consent Confirmation*

By submitting this application, I confirm that I have read, understand, and consent to the media consent form above, should I be selected and choose to participate in the clinic.
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Application Form