Full Name:

Street Address:

City: State/Province:

Zip/Postal Code: Country:

Home Phone Number: ex. 928-555-1212

Alternate/Cellular Number: ex. 928-555-1212

Fax Number: ex. 928-555-1212

Email Address:

Select Course choose the course you would like to take BodyWork Dentistry Hoof Care Holistics

Select Course Date & Location choose your course date & location April 7-11, 2008 - Sonoita, Arizona August 2008 - Lyons Colorado October, 2008 - Del Rio, Tennessee

Previous formal education and training, association memberships, etc.:

Number of years working with horses:

Horse handling experience, courses, schools etc.:

Any health concerns or physical limitations?
(These courses can be physically demanding):

Age: Height: Weight:

Reason for attending this course/
What do you expect to get out of this course?: