Application for 3-Day Equine Sports Massage Clinic

3-Day Equine Sports Massage Clinic

Conscious Horsemanship

Program application

Name: _________________________________________

Address: ________________________________________

________________________________________________

Phone Numbers: ___________________________________

Date of Birth:____________________Gender:____________

Occupation:___________________________

Email:_______________________________

Please list two Equine References (other than family). Please indicate the nature of your relationship: i.e. Trainer, Client, Vet, Farrier

Name:______________________________

Phone:______________________________

Nature of Relationship:__________________________________

Name:______________________________

Phone______________________________

Nature of Relationship:____________________________________

Which Clinic do you wish to attend?

Clinic Title:_______________Clinic Dates:__________________

Please attach a brief biography that summarizes your experience with horses and your motivation for attending our clinic. Please also attach a recent photo of yourself.

In case of an emergency, please provide a contact person:

Name:___________________________Phone__________________

City, State:_____________________________________________

Nature of Relationship:____________________________________

Please print out this application, complete it in detail and mail it to us with your tuition payment (check, money order, credit card).

You may pay your tuition deposit by either check or credit card.

Checks should be made payable to Animal Dynamics.

Enter any promotion code here:_________________

Credit Card Type & Account Number:

__________________________________________________

Expiration Date:_____________________

CVC Code:______________

Please provide the credit card billing address if it is different that the contact address which you supplied above.

Applicant Signature:_____________________________________

Date:______________________

Thank you for your interest in our clinics!

We are looking forward to working with you!

A detail confirmation package will be sent to you soon!

Please print out this application, complete it in detail and mail it to us with your tuition payment (check, money order, credit card).

Animal Dynamics

9791 NW 160th Street

Reddick, FL 32686

Upon receipt of your application and tuition payment, we will send you a confirmation package with all details specific to your clinic.

In the event that you cancel your enrollment, $100 of your tuition is non-refundable, but may be applied to a future class.