FALL 2019 Registration Form

Please Print and fill out the following application to join us on the next trail ride.

A copy of Current NEGATIVE Coggins is Required with Registration

Name - Rider 1 ________________________________________________________________

Name - Rider 2 ________________________________________________________________

Name - Rider 3 ________________________________________________________________

Name - Rider 4 ________________________________________________________________

Address _______________________________________________________________

City ______________________________________ State ______________ Zip _______________

Phone (_______) _____________ - ___________________

E-Mail _______________________________________________________

Adult (18 and over) _________________ x $50.00 each

Youth (17 and under) ________________ x $35.00 each

Late Registration __________________ x $10.00 each Adult (Registrations not Post-Marked WITH payment enclosed by September 9, 2019)

Total Amount Enclosed $ ___________ . 00

Vegetarian __________________

Price includes camping, Saturday Lunch and Dinner

Friday Dinner, Saturday and Sunday Breakfast are optional and available for an additional cost at the Dining Hall.

Make Check Payable to: Amelia Springs Trail Ride

Mail to: Jennifer Vaughan
P.O. Box 70
Crozier, VA 23039
Phone: 757-635-4300

E-Mail: ameliatrailride@gmail.com

Click HERE for the Waiver form that must be signed for each rider and mailed in as well.

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