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Club Member
Club Administration

Pauatahanui

Member Registration

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Membership Category:*

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Member Details

Title:

First Name:* Please enter first name

Last Name:* Please enter last name

Date Of Birth:* Please select date of birth Please enter a valid date

Sex:

Email:* Please enter email Invalid email

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Alternate Email2: Invalid Email

Residential Address

Address:* Please enter address

Suburb:* Please enter suburb

Country:

State:

Post Code:* Please enter post code

Home Phone:

Mobile:* Please enter mobile

Mailing Address

Address:

Suburb:

Country:

State:

Post Code:

Work Phone: Ext:

Fax No.:

Other information

Rider FEI:

Rider EA:

Occupation:

Financial:

Do you hold a current First Aid Certificate?:*

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Yes

Required field is missing

Pony Club Examiner Level (if applicable):*

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Pony Club Coaching Level (if applicable):*

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Ethnicity - Choose from the following options:*

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Asian

Do not wish to answer

Maori

Middle Eastern/Latin America/Africa

NZ European

NZ Maori European

Other

Pacific Peoples

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Do you give approval for your rider(s) to feature in our club social media posts?:*

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Yes

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Email address is already assigned to a member,
please use an alternative email address.

You appear to be an existing member.
Do you want to renew your membership?

Primary member must be over 18 years of age.

Aged pension membership is for members over 65 years.
Please choose another membership type or correct your date of birth.

EA number does not match member name.

To be eligible for this membership, a doctors certificate/para classification/RDA associate membership must be provided to the club to receive a code to apply for this membership type. Please type code in below.

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