Registration Form

Please Print and fill out the following application to join us on the next trail ride.

Name ________________________________________________________________

Address _______________________________________________________________

______________________________________________________________________

Phone (_______) _________________ - ___________________________

E-Mail _______________________________________________________

Adult (17 and over) _________________ x $60.00 each

Youth (11 through 16) ________________ x $30.00 each

Number age 10 & Under ______________ No Charge

Amelia residents ___________________ x $40.00 each

Total Amount Enclosed $ ___________ . 00

Help us plan meals !!!!!
How many are attending ?

Fri. _________ Sat. ___________ Sun. _____________

Vegetarian __________________

Make check payable to: Amelia Springs Trail Ride

Mail to: Wanda Walker
14340 Bent Creek Rd
Amelia Va, 23002

E-Mail Wanda at saddleupbilly@yahoo.com

I understand I am riding at my own risk and that ride officials,
land owners and the Amelia Springs Hunt Club are not responsible
for my safety or loss of property.

Signature _________________________________________________________
(If under 18 adult must sign also)

Adult Signature _____________________________________________________

( Please use one release form for each person attending. Copy as needed.)

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