REGISTRATION FORM

Driving Clinic with Kail Palmer-Miller

Sunday May 4th - Canvasback Farm (1380 Hopewell Rd, Port Deposit, MD 21904)

*** CLINIC FILLED - REGISTRATION CLOSED EXCEPT FOR AUDITERS***

For questions or more info contact Ann Dome (Cell: 610-999-9675 or email: adome@clermontfarm.com)

To CONFIRM your registration status, CLICK HERE

Payment

ONLINE REGISTRATION FORM

What are you registering for?

Auditor: $25

First Name

Last Name

Email

Phone

(###)

###

####

Emergency Contact Name & Phone #

Age if under 18:

Name & cell phone # of accompanying adult (if under 18):

Which documents did you upload?

BVDC Waiver

Coggins

Vaccination Record

None - I will mail paper copies

None - I will upload later using the Document Uploader on the BVDC Forms page

None - I already submitted this year

Notes for Event Secretary

Documents that must accompany registration:

• Copy of current negative Coggins test (within one year) and Flu/Rhino documentation (within 6 months) per ADS rule GR-6.3

• Signed BVDC Release - Everyone in your group must sign this (you can use one form for all signatures). CLICK HERE to download the form so you can print it.

If you have already submitted the above documents for this year, you do not have to re-submit.

You can upload the above files online using the Registration Form or later using our Document Uploader

OR, they can be emailed to: debby.donovan@comcast.net

or paper copies mailed to:

Debby Donovan, 47 Quaker Neck Rd, Salem, NJ 08079

Payment options:

• A check in the appropriate amount, made payable to: BVDC

Mail check to Debby Donovan at the above address.

• OR, you may pay online using PayPal - see below.

Note: you do not need to have a PayPal login to pay by credit or debit card.