'Return to:  Kathy Burgoyne            LCAC  HORSEBACK RIDING_______ DRIVING_______ 
                  101 Santamore Rd                              PROGRAM LOG SHEET
                   Churubusco, NY  12923                                                                        9/1/___ thru  8/31/___

Rider’s Name: ____________________________Address: __________________________________

Horse’s Name (A)____________________________________________
Horse’s Name (B)____________________________________________
Horse’s Name (C)____________________________________________
Horse’s Name (D)____________________________________________
Horse’s Name (E)____________________________________________

*Rider’s Age: _______ (as of Jan. 1st  award year)           Phone # __________________________

Total Hours: __________  Total Hours: _________  Total Hours: __________  Total Hours: _________
YEARLY TOTAL:  Hours ___________  Minutes __________                            Page total _________

REMINDER:  Membership dues are due by January Banquet.  Hours will NOT count until dues are paid.