“THE CHARLESTON EQUESTRIAN” 2012

Supporting REIN and SHINE

REGISTRATION FORM

Parent’s Names: _____________________ _______________________ and/or _____________________________ (Or Rider if Adult) Family Name Parent’s First (w/Title) Spouse’s First (w/Title) (if applicable)

Home Address: ______________________________________City/State/Zip____________________________ Please Circle Primary Contact Number and Contact Person

Home Phone:_________________ Her Work Phone:______________ Her Cell:_________________

Other Phone:_________________ His Work Phone:_______________ His Cell:_________________

Email Addresses: Hers:___________________________________His:__________________________________

Barn Association: ____________________ Trainer _________________________ Please list days and times that the rider is normally at the stables and available for pictures. We will contact you to schedule your photo shoot._________________________________________________________________________ ___________________________________________________________________________________________

Please Enroll Me or My Child Listed Below in the 2012 “THE CHARLESTON EQUESTRIAN” Program

Rider’s Name:_____________________________Age:______ DOB: Month_____Day_____Year______

Rider’s Email:_____________________________ Cell:_____________________ Is It OK to Contact ______

My donation for $95.00 for __________________________to participate in the “THE CHARLESTON EQUESTRIAN” PHOTO BOOK PROJECT benefiting the REIN and SHINE Charity is enclosed. I understand that I will be called by Signature

Photography to set up the Pre-Consultation and the Photo Session appointments and understand the terms stated in the “TCE Just the Facts” document published on the “THE CHARLESTON EQUESTRIAN” Website.

____________________________________________ ____________________ Parent’s Signature (or Rider, if Adult) Date

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Please make your donation payable to REIN and SHINE and send it with this signed form to “THE CHARLESTON EQUESTRIAN”, c/o Signature Photography, 320 East Bay Street, Suite C, Charleston, SC 29401. You may pay by check

or by credit card using the form below. Credit Card Information

Type: ____________ Card Number: ______________________________ Security Code: _____ EXP:____/____

Name on Card: _____________________ Billing Address of Card: ______________________________________ Questions? Please call the studio: 843-300-3333 Website Information: http://EOC.SignaturePhotography.Biz