Clinic Registration Form

Clinic Registration Form

Sommer Strides Horse Training LLC
Select Clinic*
Select Clinic Date*
Participant Details
Full Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Best way to reach you*

CallTextEmailFacebook
Horsemanship Level*

BeginnerBeginner/AdvancedIntermediateAdvanced
Emergency Contact Person*

First NameLast Name
Emergency Person Phone Number*

Area CodePhone Number
Registration Payments
Are you a current member of the North Central Liberty Horse Club*

YesNo
Payment*
prevnext( X )
Clinic Deposit$100.00

Virtual Clinic Payment$40.00

Quantity

Virtual Clinic Payment (member discount)$35.00

Quantity

Subtotal $0.00Shipping $0.00Total $0.00
A non-refundable $100 deposit is required for ALL clinic registrations to secure your spot.

*A 3% fee will be applied to Paypal payments.
Should be Empty:

Participant Details