Regional Activity Registration Form
Use this form to register for Regional Preps, Camps and Activities
Clear selection
Member Information
Please complete the answers to each question
Member Name
Member Club
Member Phone
Member email
Certification Information
Current Horse Management Certification Level
Current Mounted Certification Level
2020 Testings
Please indicate date, location, discipline and certification level of intended testings in 2019
Intended 2020 Testings
Early-Bird Registration
Deposits will be accepted until February 15, 2019. This $50.00 deposit reduces your overall activity cost to the amounts listed below. You will need to include a $50 deposit for Each activity that is eligible for the early-bird rate that you sign up for. If you will be taking advantage of this opportunity please select below.
Check all that apply
Non-Early-Bird Registration
Sign up after February 15, 2020.
Check all that apply.
Please submit earlybird deposits along with the Earlybird form which can be found on the regional website Forms page. Send all payments Regular Mail with your check payable to USPC Northwest Region, C/O Michele Moser 9024 105th Ave NE Lake Stevens, WA 98258


go to PayPal button that is located on the prep's calendar date on the NW region website
Refund Policy
$50 Deposit is not refundable or transferable at any time. If you cancel 30 prior to the start date, then you will receive all money paid expect the $50 deposit with a Dr. or vet note.
Overnight Activities
Please complete the information below for overnight activities
Camping (If applicable)
Clear selection
Extra Horses
Stabling if Mounted Activity
Complete Chaperone Information for all activities
Chaperone Name
Chaperone Phone
Contact Information
Please complete the information below as this is where all information will go thru.
Contact Name
Contact Email
Contact Phone Number
Person completing this form
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