Reservation Form
PRINT AND RETURN WITH RESERVATION FEES TO DACY LARSON WOODS
(Please list name & address of each rider on separate sheet of paper)
NAME______________________________________________________________________________
ADDRESS__________________________________________________________________________
CITY, STATE, ZIP____________________________________________________________________
EMERGENCY CONTACT (NAME & PHONE)______________________________________________
# OF RIDERS __________X__________________COST OF RIDE
# OF RIDERS UNDER 12_________X__________________COST OF RIDE
Please Indicate Ride
Carry's Cavalry ---- May 2-3 _________Trail Ride ------------ May 9-10 ___________Trail Ride ------------ May 16-17 __________KS State Mule & Donkey Show Benefit ride -----June 13-14 __________All Mule Ride -------Oct 10-11 ___________TOTAL ENCLOSED
VISA______MASTERCARD________CHECK__________
NAME ON CARD_________________________________
CARD NUMBER__________________________________
EXPIRATION DATE_______________________________
CHECKS & MONEY ORDERS ARE ALSO ACCEPTED
Contact: Dacy Larson Woods at 620-886-5630 ------ 6:00 PM to 9:00 PM
109 Kelly, Medicine Lodge, KS 67104
