Membership Registration

Membership Type:

First Name:

Middle Initial:

Last Name:

Sizing

Shirt Size:

Jacket Size:

Mailing Address:

City:

State/Province:

ZIP/Postal Code:

Country:

Shipping Address:
(If Different)

Email:

May we communicate with you via e-mail?

Yes

Business Phone:

Home Phone:

Cell Phone:

How did you hear about WCB?

List 3 clinicians you would like for future educational opportunities:

What clinic topic would catch your interest enough so you would attend?

OPTIONAL BIO INFORMATION:

This information will enable us to provide a more personal experience for you and your family members at each event. Information is also important demographic information for us to utilize in obtaining sponsorship. We would appreciate you considering furnishing the following information.

Are you married?

Yes

If Yes, list Spouse’s First Name:

Do you have children?

Yes

If yes, please list names and ages:

Applicant's Birthday:

Years of Shoeing Experience:

Specialty in Shoeing:

Education:

Professional Certifications:

Number of Clients:

Number of Horses Cared For:

Membership in other professional farrier organizations:

Accomplishments/interests within the farrier industry:

Accomplishments/interests outside the farrier industry:

Goals:

2 Things you enjoy about competing:

OPTIONAL BIO INFORMATION:

THANK YOU SPONSORS