Horseshoeing Course Application

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone No.

Alternate Phone No.

Email

Birth Date

Age

Sex

Height

Weight

Civil Status

Desired Class Date

Dorm

Transportation

GI BILL / OTHER SCHOLARSHIPS

Educational Level:

Disabilities (if any)

Where did you here about us? *

Others (pls specify)

Credit Card Type *

Card Holder Name *

Name on Card

Card Number *

Card Number

Expiry Date *

Security Code *

I have fully read and understand this Agreement. *

By filling up the fields above I do authorized Oklahoma State Horseshoeing School to charge this card in the amount ($150) specified on this agreement.

Phone

76142

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