Mirka Crew's Clinic Hosting

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

Clinic Topic (choose max. 2 options)

Clinic Level

Clinic Format

Add a Lesson Day; 8 Lessons per day. Days are typically added before the clinic.

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.

Clinic Hosting Form