Opening date: April 10, 2017 Closing date: May 8, 2017
Riderís Name____________________________Horseís Name_____________________________

Riderís Level_____________________________Horseís Level_____________________________

Riderís Address__________________________________________________________________

Home Phone_____________________________Cell Phone_______________________________

Riderís USEA number______________________Email___________________________________

Instructorís Name and Phone number_________________________________________________________________________

Information helpful for group placement, including competition history of this rider/horse pair:

Will stabling be necessary?_________ How many nights? _____ May 25__ May 26__May 27__
There will be limited stabling available, and may be off-site. (circle dates needed)
Please call 802-649-8810 to discuss stabling availability and price.

Please mail all forms and check to: Mary Piro, Pirouette Farm, 96 Hogback Rd., Norwich, VT 05055

Please include:

_____Check for $400 (not including stabling) Check made out to: Pirouette Farm
_____Coggins (within 1 year of clinic)
_____Pirouette Farm release form
_____USEA release form
_____Clinic Registration Form

Refunds for cancellations will be given only if the space can be filled

Registration Form
May 26-27, 2018
Pirouette Farm
Buck Davidson Clinic
Please print this page and mail in