Paul Dufresne Clinic
Training for Courage
At Largo Canyon School, Counselor NM
September 11-15, 2006

First Name: Last Name:
Mailing Address

Street address:
Street address:
City:
State or Province:
Postal code:
Country: 		Home phone:
email address:
Emergency Contact: Person, relationship, phone number
Medical Alert info: allergies, medications, conditions
 Food Restrictions:What you won't or can't eat
Horses Name: Breed and size:
Sex and age:
Stallions subject to approval - call first 1-800-365-5008		 Use: eg. roping, trail
Needs or problem: What you want to work on, limit 200 characters.
Tenative Arrival date: Traveling via:
Other info you want us to know: Anything, limit 200 characters
I have reviewed the Largo School manual and understand that I have to do my share of the housekeeping. Link to manual (pdf) I acknowledge that horses are dangerous and I am responsible for my own safety.
Deposit paid (or will be shortly) by:
Personal check (mailed)
Credit card (phoned in)
Paypal
Online bank tranfer 		How did you find out about the clinic?
Paul Dufresne
Largo Canyon School
Magazine
Web advertisement
Poster
From a friend
Other