Mirka Crew's Clinic Hosting

Clinic Hosting Form
Clinic Host's Name; the person filling out this form*

First NameLast Name
Clinic Host's Email*
example@example.com
Clinic Host's Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Facility's Name*
Facility Address - Location of the Clinic*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Facility's Owner

First NameLast Name
Facility's Owner's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Facility's Owner's Email
example@example.com
Directions to the Facility from a nearby Hwy. or Interstate*
Closest Airport*
Dates Option #1*
Dates Option #2*
Dates Option #3*
LibertyPosture Focused Training on the GroundPosture Focused Training under SaddleBridlelessWestern Dressage
IntroNoviceIntermediateDistinguishedAdvanced
2x Half Days2x Full Days3x Half Days3x Full Days
1 Lesson Day2 Lesson Days3 Lesson Days
Arena(s) Type(s) and Size(s) (outdoor/indoor, footing, type of fencing, other important info...)*
If the Facility arena is not covered, is there a haul in option in case of bad weather? YES or NO? If YES, how far from the host's facility and location/town name.*
Facility Arena Rental Fee $ per day (this fee will be split among participants)*
Is a Round Pen Available? YES or NO and SIZE & FOOTING TYPE if YES.*
Type of accommodations options for the clinician (Mirka Crew) and distance from the facility (room in host's house, camper, hotel, cabin, other...)*
Are leashed dogs allowed at this facility? YES or NO*
# of stalls available (if any, if none, put 0 here)*
Stall Fee $ per night *
# of paddocks for turn out available (if any, if none, put 0 here)*
Paddock Fee $ per night
# of RV hook ups available (if any, if none, put 0 here)*
RV Fee $ per night
# rooms for lodging available (if any, if none, put 0 here)*
Lodging $ Charges
Any other information you wish to share:
Comments, questions, more information.
Should be Empty:

Clinic Hosting Form