Pony Up and Paint Registration

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Name

First Name *

Last Name *

Enter your email address (Required)

Phone # (Required)

Phone

Preferred method of communication

List any we should be aware of

Food Allergies and Dietary Restrictions

Please download and return this general release and liability waiver to knelson@horseshelpswi.org. We will also have some on site for you to sign.

Select ticket to complete registration

Cardholder Name (Required)

Credit Card # (Required)

Visa MasterCard American Express Discover

Expiration Date (Required)

Security Code (Required)

Visa®, MasterCard® & Discover® cardholders
Your security code is the 3-digit code at the end of the signature field on your card's back.

American Express® cardholders
Your security code is the 4-digit code located above the actual credit card number on your card's front.

Billing Zip Code (Required)

Cover the fee associated with this online transaction?

Yes, I will pay an additional {transaction_fee} to cover the cost of this transaction.

Cover the fee associated with this online transaction?

Your total payment will be .

Your credit balance will cover

Your credit card will be charged

Your bank account will be charged

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