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Contact Information: - view our Privacy Policy

Your Full Name: *		Business Name:
Phone #		Business Address:
Email:  *		City:
Make sure that your email address is correct!		State:  *	Alabama Arizona Arkansas California Colorado Connecticut Florida Georgia Idaho Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachuesetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Wisconsin
		Zip Code:
# of Years in Business		N/A 1 2 3 4 5 6 7 8 9 10-15 16-20 More than 20
# of Years of Experience		N/A 1 2 3 4 5 6 7 8 9 10-15 16-20 More than 20
Mailing Address (if different from above)(Same)

Student Instruction: (You may skip to the next section if you only provide Horse Training)

Number of lessons annually:
Average cost of lessons:
Total annual student instruction income (or best estimate)
What type of teaching do you provide?	Dressage English Jumping Other Polo Vaulting Western	(Hold Control key down to select multiple types)
Total number of horses you own:
Number of your own horses used for instruction
Average number of weekly lessons on your own horses
Average number of weekly lessons on client owned horses
Number of days: On premise riding clinics
Number of participants/day: On premise clinics
Number of days: Off premise riding clinics
Number of participants/day: Off premise clinics
Helmets required?	Yes	No
Heeled shoes required?	Yes	No
What other safety gear and/or precautions are used?

Horse Training:

Number of non-owned horses trained monthly:
Cost per month
Annual Income Estimate for Horse Training:
Average value of non-owned horses trained:

    (If applicable)
    Current insurance company   
    Policy expiration date           

Comments, or special notes (optional)