Registrant Information
Name:
E-Mail:
Phone:
Address:
City:
State:
Zip:
Cash Sponsors
Gold Sponsor - $1000
Silver Sponsor - $500
Bronze Sponsor - $250
Shooter Registration
Team (5 Adults) - $600
Individual Adult - $125
Individual Youth - $75
Super Raffle Tickets
I would like to purchase
Super Raffle Tickets: $100 Each = $
Total
I/We will be Attending, but not Shooting
are looking forward to the meal & door prizes! $35 Each = $
Total
Sorry, We cannot Attend...But would LOVE to make a Contribution
I would like to make a contribution in the amount of $
Payment Information
Total Payment: $
Payment Method:
Please Select One ---->
Cash
Check
Visa
MasterCard
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Discover Card
Check Number (payable to Equine Angels):
Card Number:
Expiration Date:
(MM/YY)
Name as it appears on card:
Shooter #1 Information
Information is the same as the Registrant Information
Name:
Address:
City:
State:
Zip:
Shooter #2 Information
Name:
Address:
City:
State:
Zip:
Shooter #3 Information
Name:
Address:
City:
State:
Zip:
Shooter #4 Information
Name:
Address:
City:
State:
Zip:
Shooter #5 Information
Name:
Address:
City:
State:
Zip:
Purpose
Program Description
Program Uniqueness
Horseback Therapy
Aquatic Therapy
Benefits
Corporate Information
Staff Bios
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Spencer Gray
Cormac Kennedy
Jared Silvas
Jaycee McGee
Paris Crosby
Lauren Taylor
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You Can Help
Sporting Clays Fundraiser
Golf Tournament
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Sponsors
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Vision
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