�Adoption Order Form

Registered Chincoteague Ponies For Adoption:
___ Crackerjack of Assateague,(copperStallion)                         ___ Miss Arrow HeadNine(tri-colored pinto Mare)
___ IceCreamSundae(tri-pinto Mare)                                          ___ B.G.Black Gold Stallion(jet solid black) 
___ Miss Ginger of Assateague(solid sorrel Mare)                      ___ SeaFoam(solid white with bay medicine hat, stallion)
___ Black Diamond(solid Black with a white diamond on her forehead, Mare)     ___ foals.
 .
Please check your choice.

Annual Adoption Fee: $50 Donation (By check or PayPal using GFreder426@aol.com)
Includes: Color photo, personalized adoption certificate, fact sheet about your pony and additional Chincoteague Pony Farm information.

NAME:__________________________________
ADDRESS:_______________________________
CITY:______________ STATE:__________ ZIP:__________  Country____________
Country Code______________________
PHONE:______________________
EMAIL:_______________________

Gift Recipient (if gift):

NAME: ______________________________________
ADDRESS: __________________________________
CITY: _________________STATE: _______ZIP:��_______
COUNTRY ______________COUNTRY CODE__________
PHONE:_________________________
EMAIL:________________________

GIFT MESSAGE (optional): ________________________________________________________________________________ ________________________________________________________________________________

Please print off form and fill out.
Please mail your remittance and the above form to:

The National Chincoteague Pony Association
2595 Jensen Road, Bellingham, WA 98226

360-671-8338 voice mail
360-671-7603 fax
www.pony-chincoteague.com
www.pony-chincoteague.org   
A non-profit Organization

	Black Diamond   B.G. BlackGold Stallion
	Crackerjack Stallion   Foals
	Miss ArrowHead Nine Mare   SeaFoam Stallion
	IceCreamSundae Mare   Ginger of Assateague Mare