Wiarton Ride Registration Form

Wiarton Ride Registration Form
Current Chesley Saddle Club Membership Application has been completed and paid for.*
To participate in the Chesley Saddle Club Ride you and your families must be members. Please complete the membership form here if not already a member.
Membership
Please indicate if you are planning to Day Ride or Camp
Attendance Plan Primary
Primary Member Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Emergency Contact

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.
Please contact a member of the executive if for some reason you are no longer able to attend after registration. Thank You

Emily Nonkes emily.uyl@hotmail.com

Joan Karr rjkarr55@gmail.com

Ron Karr rjkarr55@gmail.com

John Gillberry jkgillberry@gmail.com
Please only register individuals for one family unit, with the same arrival and departure dates on this form. If registering for frien
Arrival Date*

MonthDayYear
Date
Departure Date*

MonthDayYear
Date
Attending Spouse/Partner

First NameLast Name
Will you have dependents at this ride:*
How many dependents:*
Dependent under 21 years of age.

First NameLast Name
Dependent under 21 years of age.

First NameLast Name
Dependent under 21 years of age.

First NameLast Name
Dependent under 21 years of age

First NameLast Name
Dependents Under 21 years of age.

First NameLast Name
Dependents Under 21 years of age.

First NameLast Name

Membership