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Registration Form

Millstone Township Trail Event

Millstone River Inaugural Ride

SUNDAY, SEPTEMBER 27, 2009, Rain or Shine

Intersection of Woodville Rd. & Baird Rd., Millstone Twp. NJ

 

·         Teams may have 2 or 3 riders

·         Starting Times :   5 Minute intervals beginning from 8 AM to 12 noon

·         Times will be assigned on a first come, first serve basis & limited to 50 teams

·         Registration Deadline is September 10, 2009

·         No times will be held without full payment, a completed registration form,

proof of a current (within 24 Months) negative coggins, a signed release form for all team members (a parent or legal guardian must sign for all riders under 18 years of age).

                               COST

Riders . (____@ $30.00 each, includes a box lunch) . . . . . . . . . . $_________

 

REGISTRATION

                                                Desired Start Time:  (Please indicate 1st, 2nd & 3rd Choice)

                                ________ 8:00 – 9:15    _________ 9:20 – 10:30   _________ 10:35 – 12:00

Please enclose a current coggins for each horse and a signed release for each rider

A post card or email confirming the start time will be sent to the first team member listed below

 

Team Information

 

(1)     Name ___________________________________ Phone:_________________  Amount $______

 

Address: ___________________________________________________________

 

Email: (secure site) ____________________________________________________

 

(2)     Name ___________________________________Phone: _________________ Amount $_______

 

Address: ___________________________________________________________

 

Email (secure site) _____________________________________________________

 

(3)     Name ___________________________________Phone:__________________Amount $______

 

Address: ____________________________________________________________

 

Email (secure site) ______________________________________________________

                                                                         Additional Lunches _____ @ $10.00 Each) =          $_______

 

I would like to become a Millstone Trailblazer (Annual Membership $25.00) . . . . . . . . . . . . $_______

 

I cannot attend, but would like to donate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  $_______

 

                                                                                              * Total Enclosed:                                   $_______

*$20.00 of your registration fee is tax deductable.  A receipt will be provided with your start time.

Please make checks payable to Millstone Trailblazers

   Mail to:  Millstone Trailblazers, 145 Baird Rd., Millstone Township, NJ  08535

                                                         Contact: 732-446-6863

     Cancellation Information Due to SEVERE CONDITIONS will be posted on our website at

www.millstonetrailblazers.org