Tell us how to get in touch with you:

Name	Age 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Address
Postcode
Horse or Pony Name	Height > 10 hh 10 hh 10.1 hh 10.2 hh 10.3 hh 11 hh 11.1 hh 11.2 hh 11.3 hh 12 h 12.1 hh 12.2 hh 12.3 hh 13 hh 13.1 hh 13.2 hh 13.3 hh 14 hh 14.1 hh 14.2 hh 14.3 hh 15 hh 15.1 hh 15.2 hh 15.3 hh 16 hh 16.1 hh 16.2 hh 16.3 hh 17 hh < 17 hh Age 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Telephone Number (Home)	Mobile

Please check the box if appropriate

I will be on a lead rein

Any additional information we may need:
Please state any medical conditions or allergies to this member and state any current medications

I have enclosed a cheque for £6.00
made payable to: The Burghley Branch of the Pony Club
Please mark back of cheques with rally name and date.
Thank you