The Heritage Ride Registration Ride Registration Form Build your own website. Do it yourself websites.

The Heritage Ride
Online Registration

Saturday, June 17, 2017

NOTES:  
1.  Please indicate in COMMENTS box the full names of any/all riders you are registering/paying for, if known.
2.  GROUP Registration Rate:  Please only select this rate if you are paying for a group of 10 or more riders.


Qty Amt Title
THE HERITAGE RIDE AT GREENLAND OPEN SPACE IN DOUGLAS COUNTY
$25.00 GREENLAND OPEN SPACE Registration for 1 Person (Please indicate RIDER NAME(S) in the COMMENTS box below, if known.) TAKE I-25 EXIT #167 REGARDLESS OF WHAT YOUR GPS MIGHT TELL YOU!
$10.00 LUNCH at Heritage Ride for 1 Person
$10.00 GREENLAND OPEN SPACE - GROUP Registration Rate per person for 10 OR MORE RIDERS ONLY (Please indicate all RIDER NAMES in the COMMENTS box below, if known.) TAKE I-25 EXIT #167 REGARDLESS OF WHAT YOUR GPS MIGHT TELL YOU!
ADDITIONAL DONATION TO CHC
$1.00 Additional Donation to CHC's General Fund
OPTIONAL MID-YEAR SPECIAL INSURED MEMBERSHIP OPTIONS (Select ONE option only)
$35.00 Mid-Year Insured Individual Membership (Membership & Insurance effective today and expiring 12/31/17)
$60.00 Mid-Year Insured Family Membership (Membership & Insurance effective today and expiring 12/31/17)
$85.00 Full-Year NOT INSURED Organizational Membership (Membership & Insurance effective today and expiring after 12 months.)

 Total Amount Due

Comments:


First Name:
 Required Field
Last Name:
 Required Field
Company Name:
Address:
 Required Field
City:
 Required Field
State:
 Required Field
Postal Code:
 Required Field
Country:
Telephone:
 Required Field
Email:
 Required Field

PAYMENT DETAILS
Please select your method of payment and provide billing information if paying by credit card. Fields marked with Required Field are only required for that specific payment type.

I prefer to pay by Credit Card
Card Type:
       
Name on Card:
 Required Field
Card Number:
 Required Field
Card Code
(what is this?):
 Required Field
Billing Zip:
 Required Field
Expiration Date:
 Required Field

I understand that by submitting this form, I am agreeing that Colorado Horse Council, Inc. will charge my credit card.


  I have read and agree to these terms.

REVIEW AND SUBMIT
Please review your information above and click "submit" below to securely process your payment.