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Lunch Order Form
Entry for Wil and Em Clinic 2021
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Indicates required field
Name
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First
Last
I wish to participate in the two day clinic with Wil and Em on the 11th and 12th January, 2021. I understand that a parent/guardian must be present while riding. By checking the box below, I am acknowledging my understanding of this.
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I understand.
Age of Rider:
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Name of Pony Club (if applicable):
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Email
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Phone:
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Insurance:
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Pony Club
HRCAV/EA/Other
Open (will attract $15 Day Attendance Fee)
Please note that although you have the option here to enter two horses, this will be limited to only one horse if we have large entries.
Open Riders requiring Day Attendance, please attach your completed form and include payment.
Fees that I will be paying:
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1 x lesson $75
2 x lessons $140
3 x lessons $200
4 x lessons $240
Yard x 1 Outside $20
Yard x 2 Outside $40
Yard x 1 Undercover $30
Yard x 2 Undercover $60
Camping $15 per family
Day Attendance Fee x 1 $15 OPEN RIDERS ONLY
Day Attendance Fee x 2 $30 OPEN RIDERS ONLY
Horse Information:
First Horse Name
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Name of 2nd Horse:
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Horse Trials Grade:
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Grade 1
Grade 2
Grade 3
Grade 4
Horse Trials Grade for 2nd Horse:
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No Second Horse
Grade 1
Grade 2
Grade 3
Grade 4
Dressage Grade Horse 1
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Grade 1
Grade 2
Grade 3
Grade 4
Address horse travelled from:
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Address horse travelling to after the clinic:
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Dressage Grade Horse 2
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Grade 1
Grade 2
Grade 3
Grade 4
Address 2nd horse travelled from:
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Address 2nd horse travelling to after the clinic:
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Total Paid:
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Bank details:
Mansfield Pony Club
BSB: 633000
Acc: 140751975
Please upload a copy of your proof of payment here:
Upload Proof of Payment Here:
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Max file size: 20MB
Completed Day Attendance Form (if applicable):
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Max file size: 20MB
Please upload a picture of your current grading card or proof of membership to another organisation.
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Max file size: 20MB
Upload 2nd image of membership if applicable
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Max file size: 20MB
Comment
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Please comment here if anything not right with your entry above or if you can please clarify which horse you will be riding for each lesson you have chosen. Thanks.
Thanks for entering our clinic, we hope you have a wonderful time.
If you have any queries about your entry please contact Lauren Lines on 0438344097.
Lessons I would like to participate in:
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SJ x 1
SJ x 2
SJ x 3
SJ x 4
Dressage x 1
Dressage x 2
Dressage x 3
Dressage x 4
XC x 1
XC x 2
XC x 3
XC x 4
Submit