Clinic Registration Form

Clinic Registration

Online Registration with direct PayPal payment only.

All participants: please fill out the top section.

* Indicates required field

Name *

First

Last

Phone Number *

Full Address *

Email *

Trainer Name *

Barn (CDCTA Supporting Barn of the Year) *

Rider's Only:

Emergency Contact *

Emergency Contact Phone # *

Horse's Name *

Color *

Height *

Rider Experience *

Horse Experience *

Select Clinic Level: *

Coggins Upload *

Max file size: 20MB

Does CDCTA have a current Coggins & Rabies on file for 2021? *

Rabies Upload *

Max file size: 20MB

All Participants: please select from the following options:
Auditor Online Payment Ends Friday by Noon.

CDCTA Members: *

Non-Members *