Pony Adoption Form

Please fill in this form,print it out and post it with your cheque for £12.00 :
Jane Sanders, Epsom RDA, St Ebbas Farm, Hook Road, Epsom, Surrey, KT19 8QW

Your adoption will be processed as soon as your cheque is cleared. Thank you for supporting Epsom RDA!

First Name of certificate holder
Surname of certificate holder:
Address of certificate holder:
Postcode:
Your Telephone Number:
Your Date of birth (or the person you are adopting for if it is a gift)
If the adoption is required for a special date please specify:
Name of pony you wish to to adopt :
Your E-mail Address:
If you want a special message to be included please enter it here? Eg:"Happy Birthday"
Is this a renewal Adoption?	Yes No