Regional Activity Registration Form
Use this form to register for Regional Preps, Camps and Activities
Member Information
Please complete the answers to each question
Member Name
Your answer
Member Club
Your answer
Member Phone
Your answer
Member email
Your answer
Certification Information
Current Horse Management Certification Level
Your answer
Current Mounted Certification Level
Your answer
2020 Testings
Please indicate date, location, discipline and certification level of intended testings in 2019
Intended 2020 Testings
Your answer
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.
Payment
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

or

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)
Extra Horses
Your answer
Stabling if Mounted Activity
Your answer
Complete Chaperone Information for all activities
Chaperone Name
Your answer
Chaperone Phone
Your answer
Contact Information
Please complete the information below as this is where all information will go thru.
Contact Name
Your answer
Contact Email
Your answer
Contact Phone Number
Your answer
Person completing this form
Your answer
Submit
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