Eric Dierks Eventing Clinic Entry Form Date: July 15 & 16, 2017 Where: Rolling Rock Hunt Pony Club Grounds, Ligonier PA Clinic Costs: $225/rider for weekend $120 dressage private $25 Stabling Fri.-Sun. Closing Date: June 15, 2017 Please mail completed entry form, current coggins, and check made payable to “Rolling Rock Hunt Pony Club” to Colleen Mauro 218 Stoney Springs Rd Greensburg, PA 15601

Rider Name: Rider Age:

Rider email:

Rider Address:

Name of Horse:

Rider Experience:

Horse Experience:

Please circle which group you would like ride with:

Starter Beginner Novice Novice Training

Dressage Private (space is limited)? Yes No

Stabling (please circle)? Yes No

Stabling Requests:

Any questions please contact Colleen Mauro at [email protected] or call/text 412-736-1112