CHA ALL DISCIPLINE REGISTRATION FORM
Mail to: Rockin’ L & D Ranch
Lori Hall-McNary
1019 Deodar Road
Escondido, CA 92026
760-741-1179 home or 760-224-2483 cell
PLEASE PRINT!
Name:____________________________________________________
Address:_________________________________________________
Phone(s):_________________________________________________
E-mail:___________________________________________________
Contact person in case of emergency:______________________
Medical Conditions:________________________________________
Special diet requirements:______________________________________________
Deposit amount $335.00 of total due:_________________
Check or money order: #_____________
$635.00 Cost includes all books, CHA membership. 5 day clinic, Continental Breakfast, Snacks, Drinks & Lunch. Does not include housing or transportation. Please see website www.RockinLDRanch.com for details.
Discipline for certification:_____________________________________________