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The Heritage Ride

October 15, 2016 - Colorado Horse Park

Online Registration

Please indicate in COMMENTS box which souvenir you'd like to receive - either the Water Carrier Waist Belt OR the Backpack.


Qty Amt Title
THE HERITAGE RIDE
$50.00 Heritage Ride Individual Registration (Includes your choice of either a Water Carrier Waist Belt OR Backpack. Please indicate your choice in the COMMENTS box below.)
OPTIONAL MID-YEAR SPECIAL INSURED MEMBERSHIP OPTIONS (Select ONE option only)
$35.00 Mid-Year Insured Individual Membership (Membership & Insurance effective today and expiring 12/31/16)
$60.00 Mid-Year Insured Family Membership (Membership & Insurance effective today and expiring 12/31/16)

 Total Amount Due

Comments:


First Name:
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Last Name:
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Company Name:
Address:
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City:
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State:
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Postal Code:
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Country:
Telephone:
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Email:
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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:
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Card Number:
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Card Code
(what is this?):
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Billing Zip:
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Expiration Date:
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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.