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Membership Category:*

Member Details

Title:*

First Name:*

Last Name:*

Date Of Birth:*

Sex:*

Email:*

Residential Address

Address:*

Suburb:*

Country:

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Post Code:*

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Address:

Suburb:

Country:

State:

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Do you suffer from Allergies & or any medical condition?:*

Yes

If yes, please provide details of condition & action plan.:

Emergency contact information::

Emergency contact name:*

Relationship to you:*

Emergency contact number:*

Horse emergency contact Name:*

Horse emergency contact number:*

In the event that your horse is injured at an APEC event & you are unable to attend to your horse due to injury to yourself, please advise contact details for your Vet:

Veterinarian Name/Clinic:*

Veterinarian/Clinic Phone Number:*

In the event that APEC is unable to contact your vet, you acknowledge & agree that APEC will seek veterinary attendance, at your cost, from the nearest available vet. APEC will follow the advice of the vet & shall not be held liable, financially or in any way whatsoever, for any such decision.:*

Adelaide Plains Equestrian Club (APEC)

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