Workshop Application

2020 EI Workshop Application

Date

Name

First

Last

Phone

Address

Street

City

State

Zip

Gender

Male

Female

Emergency Contact

Relationship

Emergency Contact Phone

Year of Veterinary/ Veterinary Technician Degree/PhD:

Current Practice Type:

Specialty Training:

Please only include higher education

Other Horsemanship Skills:

Spanish Language Skills:

Profession:

Please describe your veterinary or other work background, species interest and experience:

Do you have any previous volunteer veterinary experience (either domestically or internationally)? If yes, please describe:

Why do you want to attend the Equitarian Workshop?

What do you hope to do with the Equitarian skills and experience you gain from the Workshop?

Anything else you'd like to share?

Please describe any dietary restrictions

Would you like to pay your $300 deposit now by Paypal?

Yes

If you would prefer to pay by check, submit the form with the button below and then please mail a check to:

Equitarian Initiative
PO Box 2143
Stillwater, MN 55082