Yass Valley Riding Club

Member Registration

Member Details

Residential Address

Other information

EA Membership No (if applicable):
Riding History:
Riding years of experience:
Other Equestrian clubs or interests (previous or current):
Horse's Name/s:
First Aid Information:
1. Any physical limitations or medical conditions e.g Asthma:
2. Any other relevant information concerning yourself e.g fainting, nose bleeds, long term therapy:
3. Any allergies you have e.g bee stings, penicillin (Please include any anaesthetic allergies):
4. Have you had full Tetanus immunisation:
If yes, when:
5. Medicare Number:
6. Private Health Insurance:
If yes, Fund and number:
7. Ambulance Cover:
8. Family Doctor - Name:
Family Doctor Number:
Privacy Legislation - YVRC Member Approval:
Are you happy for the YVRC to supply your name and address details to any club, YVRC or EFA sponsors?:
YVRC:
EFA Sponsors:
Are you happy for the YVRC to publish your name or captioned photograph on the YVRC website, Facebook or other promotional materials?:
YVRC Website:
Facebook:
Other:

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?

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