Trainer/Instructor Quick Quote Name* First Last Mailing Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail* Website Address*If not applicable type "none"Association Membership*YesNoIf so please check all that apply (ARIA) American Riding Instructors Association (CHA) Certified Horsemanship Association (PATH) Professional Association of Therapeutic Horsemanship Other None If "Other" please describeActivities you are involved in* Judge Group Instructor Course Designer Clinician Trainer Steward Show Official Polo Groom Technical Delegate Professional Rider/Driver Therapeutic (see the next two questions) If you are an EAAT instructor, what program are you certified with?How many years have you been certified?Average per month the number of students and/or horses you instruct*0-1516-2930-4950+Gross Annual Receipts for activities listed above*Are you responsible for 24 hour care of non-owned horses? (either by boarding contracts or horses in training)*YesNoDo you currently have a primary farm/ranch policy?YesNoDo you currently have a policy that covers any of the above equine related exposures?YesNoDo you have assistants or partners?*YesNoIf "Yes" for assistants or partners, how many?Do you use volunteers?*YesNoIf "Yes" on volunteers, how many on average per month?Do you offer any of the additional activities? Pony Rides Day Camps Horse Drawn Rides Fundraisers Sleigh Rides Horse Sales Trail Rides Other activities not listed aboveHow did you hear about us*Internet Search (Please specify words searched below)American Driving SocietyAmerican Morgan Horse AssociationAmerican Riding InstructorsAmerican Vaulting AssociationArabian Horse AssociationAssociation Resource GroupCertified Horse AssociationFriend/Stable/Referral (Tell us who to thank below)Intercollegiate Horse AssociationLinkedInMy Horse Council (Please specify the state below)Tradeshow (Please specify below)United States Dressage FederationUnited States Equestrian FederationUnited States Hunter Jumper AssociationUnited States Polo AssociationUnited States Team RopingOther Equestrian Association/Club/Council Not Listed Here (Please specify below)Other/Please Specify DetailsPlease list any additional commentsCommentsThis field is for validation purposes and should be left unchanged.