Registration Form

Note: To register as a Business Sponsor use Event Sponsor Registration Form

Special Thanks to the following Event Sponsors:

Please complete a separate form for each family.

Household Contact Information: (Parent or Guardian or Adult Rider)

First Name:

Last Name:

Address:

City:

State:

Zip Code:

Home Phone:

Cell Phone:

Email:

List ALL Participants (same household only) including Contact above if participating:

Riding or Walking

Select Team (if any)

Birthdate: mm/dd/yy

T-Shirt Size

If you are riding with a team not listed above, then enter it below. Teams are optional.

Team Name

SELECT Trail Ride Time. Registration fee is due with registration.		(Registration person cost)
9:30AM, Sep 17, 2010	2 hr Trail ride ($25 registration fee plus minimum of $75 in pledges required)	$25
10:30AM, Sep 17 2010	1 hr Trail ride ($25 registration fee plus minimum of $75 in pledges required)	$25
1:30PM, Sep 17 2010	1 hr Trail ride ($25 registration fee plus minimum of $75 in pledges required)	$25

SELECT 3K Walk Time	Registration fee is due with registration.	(per person cost)
10:30AM, Aug 14, 2010	3K Walk	$25
1:30PM Aug 14, 2010	3K Walk	$25

LUNCH		(per person cost)
I/We will be here for the 12:00PM lunch and awards ceremony. (Included in Registration Fee)
	List number of additional non-participants eating lunch with you.	$6/each


Method Of Payment:
Calculate Total due today
	Total Registration Fees = (number of participants x $25)	$
	Additional Donation (Optional) = Riders must raise an additional $75 in order to participate. If you choose to contribute personally instead of or in addition to sponsors you find then list that amount here. Gifts to Marmon Valley Ministries are tax deductible.) You may make additional contributions at any time prior to September 17th using the Sponsor Donation Form, too.	$

Total Charge Today: Add above charges together.		$

( Card holder agrees to pay the above Total Charges Today)

Master Card Visa Discover

Card Number:
Expiration Date:
Cardholders Name:

Special Instructions

List any special questions or instructions regarding your registration.

Liability Release Statement:

I understand that anyone participating in the activities (including but not limited to horseback riding and petting animals at Marmon Valley Farm assumes personal risk, and that Marmon Valley Ministries, Inc and Marmon Valley Farm, Inc will make every effort to keep participants safe. I realize that horses and other farm animals may be unpredictable because they have a mind of their own, therefore: Marmon Valley Ministries, Inc and Marmon Valley Farm, Inc will not be responsible for injuries.

Enter initials indicating your acceptance of the Liability Release Statement.

Once processed in our office, a Confirmation statement and Participant Packet will be mailed to you. Please direct questions to 937 593-8051 or info@marmonvalley.com.

Cancellation Policy
The $25 registration fee is non-refundable.