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Express Program Payment

Please use this form to process your program fees. Please use the registration form of your particular program if this is your first payment for the program. Note, this form does not complete the registration portion of your program.

Contact Information

Client Name

*

First Name

Last Name

Guardian Name

*

First Name

Last Name

Amount

*

$

Payment Schedule

Continue donating until

(mm/dd/yyyy)

Phone

Email

*

Verify Email

*

Other information

Program Fees

*

Riding Lesson

Counseling

Autism

Therapeutic Riding

Other

Instructor/Staff Member Name

Amanda Hurt

Marjorie Syrko

Meg Vanderbilt

Briana Perkins

Marcia Thompson

Toni Keating

Other