Clinic Hosting Form
Clinic Host's Name; the person filling out this form
*
First Name
Last Name
Clinic Host's Email
*
example@example.com
Clinic Host's Phone Number
*
Please enter a valid phone number.
Facility's Name
*
Facility Address - Location of the Clinic
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Facility's Owner
First Name
Last Name
Facility's Owner's Phone Number
Please enter a valid phone number.
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)
*
Liberty
Posture Focused Training on the Ground
Posture Focused Training under Saddle
Bridleless
Western Dressage
Clinic Level
*
Intro
Novice
Intermediate
Distinguished
Advanced
Clinic Format
*
2x Half Days
2x Full Days
3x Half Days
3x Full Days
Add a Lesson Day; 8 Lessons per day. Days are typically added before the clinic.
1 Lesson Day
2 Lesson Days
3 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.
Submit
Should be Empty: