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Clinic Booking Form
All enquiries to Fee Coulson on 0401 018 301
Clinic Location: ___________________________
Dates: ______________ to _________________
Name: _____________________________________________
Address: ___________________________________________
__________________________________________________
__________________________________________________
Phone number: ( )________________ Mobile: _____________________________
(please fill in a separate form for each person attending the clinic)
Clinic Fee (5 day, including all meals) _________________________________$700
Stabling (@ $22/night)
______ horses x ____ number of nights x $22________________________$____
Camping (@ $17/night)
____ number of nights x $17____________________________________$____
Fence sitter (including all meals) (5 days = $295 or $60 / day) ______________$____
TOTAL $ ______
I have included my deposit of $_______ plus my stabling and camping costs, to participate in the __________ Clinic commencing ______________. I am aware that the deposit is non-refundable but is transferable. I am also willing to complete all relevant indemnity forms relating to the running of this clinic.
SIGNATURE DATE
PARENT/GUARDIAN (For those under 18)
A $300 NON REFUNDABLE deposit paid in advance, plus the fees for stabling and camping will be required to confirm your place in the clinic. Three weeks notice must be given if you are unable to attend the clinic and it is up to the rider to find a replacement. All clinic costs must be paid in full two weeks prior to clinic.
Make cheques and money orders payable to: Carol and Warren Backhouse
Mail forms, payments and all correspondence to:
Fee Coulson
533 Claus Road
Glamorganvale 4306
Or make online payments to:
Account Name: Warren and Carol Backhouse
BSB: 484-799
Account: 200171964
(If you are paying through a direct internet deposit, please print and forward a copy of your receipt)
Any enquiries to Fee Coulson: fee.coulson@bigpond.com or
07 5426 6336 (before 7 am or night) or 0401 018 301
Please not
e: You must complete a waiver form and forward it with your booking form
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