EmailMe Form - Central Ohio Carriage Driving Sponsor Membership

Sponsor name *

Name of business as you would like it displayed.

Individual name for membership *

First Last

Primary adult for family membership or first of two names for individual memberships (second will be included below)

Billing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Primary phone for contact *

### - ### - ####

Business phone number (if applicable)

### - ### - ####

Primary Email for contact *

Business Email

Website (if applicable for inclusion on sponsor page)

Sponsor membership type *

$130 (two individual memberships)

$130 (one family membership)

Payment method *

Pay online (Pay via paypal link on membership page)

Mail check (Send to Central Ohio Carriage Driving, c/o Cheri Bregel, Treasurer, 15222 Justamere Rd, Centerburg, OH 43011-9539)

Other information:
Family membership: Please list names of others in your household.
Individual membership (x2): Please list names and contact information for second membership. *