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EAC Registration Form
Cost: $35
Introduction to Equine Assisted Counseling
Please note that all fields followed by an asterisk must be filled in.
First Name*
First Name*
Last Name*
Last Name*
E-mail Address*
E-mail Address*
Street Address*
Street Address*
City*
City*
State/Prov*
State/Prov*
Zip/Postal Code*
Zip/Postal Code*
Home Phone
Business Phone*
Business Phone*
Choose section*
Choose section*
Section 1: Saturday, March 20. 1-4:00p.m.
Section 2: Friday, April 2, 1-4:00p.m.
Section 3: Friday, May 14, 9:00a.m.-12:00p.m.
Payment Options
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Section
Section 1
Section 2
Mail in
: Print off form above and mail with check or credit card info (number, expiration date, billing address if different from the above).
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434 N. Garrett St., Central, SC 29630,
Voice: (864)508-0781, FAX (206) 309-0077
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