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Potomac Polo School
Intensive Polo Clinic
Red Eagle Ranch LLC –
Poolesville, MD
REGISTRATION AND
LOGISTICS FORM |
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Mail
a copy of this form for each participant and your payment for each person to Mary Muldoon,
Red Eagle Ranch, LLC, PO Box 447, Poolesville, MD 20837
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PLEASE
COMPLETE AND RETURN THIS FORM AND THE
WAIVER INCLUDING YOUR PAYMENT IN FULL (CHECK OR MONEY
ORDER) NO LATER THAN TWO WEEKS BEFORE THE PREFERRED CLINIC
DATES. YOU WILL RECEIVE CONFIRMATION BY TELEPHONE ALONG WITH A
CONSULTATION TO REVIEW YOUR RIDING SKILLS AND GOALS.
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LAST NAME
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FIRST NAME
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DATE OF BIRTH (MO/DAY/YR)
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STREET ADDRESS
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CITY
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STATE
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ZIP CODE
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FIRST CHOICE CLINIC DATES
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SECOND CHOICE CLINIC DATES
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E-MAIL ADDRESS
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HOME TELEPHONE NO. (with area code)
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MOBILE TELEPHONE NO. (with area code)
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OFFICE TELEPHONE NO. (with area code)
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RIDING EXPERIENCE
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POLO EXPERIENCE
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HOW WERE YOU REFERRED TO US
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DO YOU NEED LISTS OF ACCOMMODATIONS?
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CONFIRM THAT YOU WILL BRING AN APPROVED POLO HELMET WITH FACEGUARD?
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CONFIRM THAT YOU WILL BRING AT LEAST ONE 52" MALLET?
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CONFIRM THAT YOU WILL BRING RIDING BOOTS OR POLO BOOTS?
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DIETARY REQUIREMENTS (i.e., vegetarian; no shellfish)
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EMERGENCY CONTACT NAME
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EMERGENCY PHONE NUMBER
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T-SHIRT SIZE
M L XL
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COMMENTS |
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For more information, please
contact:
Mary Muldoon at 1-(301)
972-7303 or e-mail: info@redeagleranch.com |