YOUR TEACHERS | 5-DAY INTENSIVE | 2-WEEK INTENSIVE | ENROLLMENT FORM | LOCATION AND PRICING | CONTACT US

Equestrian Intensive Adventures Registration Form

Registrant Name: ______________________________________________________________

Address: _____________________________________________________________________

City: ________________________________________________________________________

State: __________ Zip: __________ Phone (day): _________________________

Phone (evening): _______________________ E-mail: ________________________________

Please sign me up for:

□ The Five Day Intensive, June 6-10 for $2500.
□ The Five Day Intensive, August 1-5 for $3000.
□ The Two Week Intensive, September 9-22 for $7500.
□ I am so excited I want to do a five day and the two week Intensive for $9,000! I have checked off the five day Intensive that I want to attend.

_____ Check _____ Money Order _____Visa _____ MC _____ Amex

Please make checks out to Equestrian Intensive Adventures

Card #: _________________________________________________ Exp. Date: ____________________

I authorize $ ____________________ to be charged to the above account on (date): _____________________

Name as it appears on the account: _______________________________________________________

Billing address for card (if different than above):

____________________________________________________________________________________

_____________________________________________________________________________________

Signature of Cardholder: _______________________________________

Date: _______________________

Link to contact us

To sign up today please contact:

Elizabeth Hanson
elizabeth@equestrian-pilates.com
703-887-2771