Alexandra’s Cross Country Club

The Island, 0848 County Road 106, Carbondale CO 81623

TEL:970.963.8056 FAX: 970.963.9058 sales@candelierart.com

MEMBERSHIP FORM

Name     _______________________________________________________________________________

Address _______________________________________________________________________________

City ________________________________         Zip      _____________        State  ______________

Home Phone _________________________       Cell  Phone  _____________________________________

E-mail  ________________________________________________________________________________

Date of Birth  ________________________         Age _______________________

Rider’s Experience     Level

Beginner                   Novice                                   Intermediate                                      Professional  

Horse’s Name  ___________________________

My horse is stabled at   _________________________________         Telephone  _________________

My trainer is       _______________________________________        Telephone__________________

I am a member of the Roaring Fork Pony Club

I am a member of the CWHJA                                   

I am a member of USEA                                                               

In case of an emergency contact

Name  ______________________________________________                       Relationship __________________

Home Phone  __________________________              Cell Phone  _______________________________________

Please indicate if you would be interested in helping to maintain the course or would like to sponsor a fence.

YES                                                 NO 

Make check payable to:           Alexandra Anwyl-Davies  for                            $35.00

And mail check to: Alexandra Anwyl-Davies, The Island, 0848 County Road 106 Carbondale CO 81623

__________________________________________________                           __________________________

Members Signature                                                                                                        Date