Missouri Fox trotter Riding Academy Registration Form  Name:  _______________________________________________________________________   Address: ______________________________________________________________________   Phone #: __________________________E-mail Address :______________________________ Date Requested: ________________________ Alternate Date: ___________________________ Foxtrotter Name: ____________________________________________   Age:______________   Circle one:  Mare   or   Gelding           How long have you had your Foxtrotter:_______________   How long have you been riding a gaited horse: _______________________________________   Have you been to any gaited clinics or formal training, if so explain: ______________________ _____________________________________________________________________________ ______________________________________________________________________________   Does your horse have any specific “Issues”  (bad habits, etc.) I need to know about:__________ _____________________________________________________________________________ _____________________________________________________________________________   What you hope to accomplish by attending the “3-Day Program”: ________________________ ____________________________________________________________________________ ____________________________________________________________________________ Emergency Contact Person: _______________________________________________________  Phone #: ______________________________________________________________________ Method of Payment (Circle One):  Check – Mastercard – Visa – Discover   Card #: _______________________________________Exp. Date: __________________     A $200 deposit submitted with your Application is necessary to confirm your reservation.    Please send Application and payment to:   Cyndi Plasch,   5548 Grassland Trail,   Middleton, WI 53562