Participant Application
First Name __________________________Last Name
__________________________
Age_____________ Gender_____________
Address
________________________________________________________________
City________________________________ Zip_____________
State______________
Home Telephone Number___________________ Cell Phone
Number______________
E-Mail___________________________________________
If Under the Age of
Eighteen –
Name of
Parent/Guardian___________________________________________________
Cell Phone Number___________________ Other Phone
Number___________________
E-Mail___________________________________________
Polo/Equine Information:
Polo Experience:
Ø
Beginner ____
Ø
Intermediate ____
Ø
Advanced ___
Riding Experience:
Ø
Beginner ____
Ø
Intermediate ____
Ø
Advanced __
USPA Rating (if applicable) ____
Member Club________________________
Fee Information
Cost: $1,800 per participant. $900 non-refundable
deposit, or full payment included with application.
Includes all clinics, low-goal tournament, instruction,
activities, and lunch.
Transportation, lodging, and eight-goal tournament, and
dinners paid separately.
We accept checks, Visa, MasterCard, and American
Express.
Credit Card Number _______________________________
Expiration Date________
Name on Credit Card________________________________
Amount: _____________
or call to make your reservations and payments over the
phone – (404) 372-8128
Denim & Diamonds Dinner
o
Cost $75 Per Adult: #_____Attending
o
Cost $50 Per Young Adult (Under 18): #_____ Attending
Rodeo and Western Dress Dinner
o
Cost $75 Per Adult: #_____ Attending
o
Cost $50 Per Young Adult (Under 18): #_____ Attending
Closing & Awards Ceremony - No Charge
o
Per Adult: #_____ Attending
o
Per Young Adult (Under 18): #_____ Attending
Are you planning on bringing your own horses? _______
How many? _______ |
