GIT UP & GLOW REGISTRATION
Mount Chance Farm, Clements, MD
Name
*
First Name
Last Name
Phone Number
*
E-mail
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Riders Full Name
*
First Name
Last Name
Riders DOB: (If over 18, "adult" is acceptable.
*
Horse/Pony Name: (Name you want announced)
*
Class Choices
*
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( X )
1. Keyhole WT
$
12.00
2. Keyhole WTC
$
12.00
3. Scramble Race WT
$
12.00
4. Scramble Race WTC
$
12.00
5. Texas Rollback WT
$
12.00
6. Texas Rollback WTC
$
12.00
7. Pole Bending WT
$
12.00
8. Pole Bending WTC
$
12.00
9. Hurry Scurry WT
$
12.00
10. Hurry Scurry WTC
$
12.00
11. Barrel Race WT
$
12.00
12. Barrel Race WTC
$
12.00
13. Dollar Bareback WT
$
12.00
14. Dollar Bareback WTC
$
12.00
OFFICE FEE
$
5.00
ALL WALK TROT CLASSES
$
75.00
ALL WALK TROT CANTER CLASSES
$
75.00
Payment Methods
Choose from one of the PayPal options to
make your payment.
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