Michael Zukerman Clinic Sign-Up Rider InformationFirst Name*Last Name*Email Address*Enter EmailConfirm Email Address*Confirm EmailAge*I will register another rider after I submit this form. Please redirect me back to this form.* No YesBilling InformationParent First Name*Parent Last Name*Address*City*State*AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWYZip Code*Deposit InformationThere is a $50 deposit to hold your spot. How would you like to pay?* I will pay the $50 deposit via check (made payable to Trinity Farm) I will pay the $50 deposit online via an invoiceClinic Class TypeI want to...* Ride in the clinic Audit the clinicChoose which class type you'd like to ride in:* 2 Hour Session 1.5 Group LessonWhich days will you be auditing?* October 29 October 30 BothTotal*$Terms of AgreeementWarning: Under Tennessee Law, an equine professional is not liable for an injury to or the death of a participant in equine activities resulting form inherent risk of equine activities pursuant to TSA, Title 33 Chapter 20. Signing and presenting this form shall be deemed acceptance of the above terms in agreement to comply with the rules and regulations listed on the class schedule and on this entry form. Responsible Party Signature*ClearDate of Signature*If you are human, leave this field blank.