FLATWOODS FARM Equine First Aid Registration Form

EquiHealth First Aid Registration Form--FLATWOODS FARM

Please complete all fields in the registration form. You will receive a confirmation email with class details, and payment instructions if you choose to skip PayPal. Classes must be pre-paid and paid in full to ensure the proper amount of class materials and meals (if applicable). Funds are transferable but not refundable. This form needs to be completed for EACH participant. If you need assistance completing this form please call or text Jackie at 321-213-4784. Thank you.
Student Name*

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Student E-mail*
Mobile Number*

Area CodePhone Number
Phone Number

Area CodePhone Number
Equine First Aid Course Presentation:*

$170 Equine Health & Emergency First Aid at Flatwoods Farm; light lunch & refreshments included; located at 430 Grant Rd Palm Bay FL 32909; class is from 9am-4pm
Please provide any other courses you may be interested in. A list of Equine First Aid and Emergency Planning courses available on www.equi-firstaidusa.com
Instructor will contact you directly when the next course is being offered
Please indicate if you have any food allergies: blanksblank
PAYMENT: If the PayPal option below appears disabled OR if you prefer to use a different payment method (Zelle, Venmo, Cash, Check), submit your registration without payment and I will follow up with an email to include alternative payment options. Any questions, call or text Jackie 321-213-4784.
Registration payment. Select *ONE*
prevnext( X )
Single Participant ONE full-day class$170.00
Select if you plan to pay by credit card or PayPal.

Total $0.00

EquiHealth First Aid Registration Form--FLATWOODS FARM