Pre – Registration for the SRS Open
USDF accredited Dressage Clinic
Name:
__________________________________________
Address:
_________________________________________
Phone:
________________E-mail_____________________
IEO membership
Number____ (you do not have to be a member to attend)
The Clinic will be held on July 21 through 25, 2010
Are you interested in Auditing? _________If so which dates ____________________?
Which dates are you interested in Riding?___________________If so which dates__________________________
Do you wish to receive USDF
University Credits ________
Do you have a
preferred time?___________________________________________________________
Do you wish ride with one other person? ___________(You will pay half price/if a ride partner can be found)
Are you interested in attending the Dinner with Christian July 23rd at pm at the Manor Tavern _______________How many attending_________
Clinic will be held at: Four Winds Farm
5157 Jolly Acres Road White Hall, MD 21161
Starts at 7:30 a.m.
Clinic Fees
Plus USDF fee $5
Lessons are:
$180 plus usdf fee
…………………..
$100 per ride non refundable but
transferable deposit required when booking
All Riders
please include your Neg. Cogging, current shots including rhino /EHV
( The Rhino shot must be within 30 days but no less than 10 days prior to clinic) with your release, Survey & Usdf info.
……………………………………
In Consideration of being permitted by Melanie & Tom Adams & Four Winds Farm., (the Clinic/Farm) to enter onto the premises and participate in a program or activity. I hereby agree that I, my assignees, heirs, distributes, guardians, their legal representatives will not make a claim against, sue, or attach the property of where the clinic will be held in addition to Melanie Adams, York IEO, MDA, & any of its sponsors, clinicians, or any of their principals, agents, employees or representatives, for injuries or damages resulting from the negligence or other acts, conditions, or circumstances, howsoever caused, by any principal. Agent, employee, clinician, or representative of Four Winds Farm and its sponsors or its representatives. From all actions, claims, or demands that I, my assignees, heirs, distributes, guardians, or legal representatives now have or may hereafter have for injury or damage resulting from my presence at The Clinic or from my participation in a program or activity at The Clinic.
Signature____________________________. Date__________________
_________________________Signature of Parent /Guardian if rider auditor is under
21.
You can mail forms to and make checks payable to:
Melanie Adams c/o SRS clinic 5157 Jolly
Acres Road White Hall Maryland 21161
Please
submit your forms and money now to reserve your slot limited space available.