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Membership Category:*

Member Details

Title:

First Name:*

Last Name:*

Date Of Birth:

Sex:

Email:*

Alternate Email1:

Alternate Email2:

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Address:*

Suburb:*

Country:

State:*

Post Code:*

Home Phone:*

Mobile:*

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Suburb:

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Work Phone: Ext:

Fax No.:

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Do you have Ambulance Cover?:*

Yes

PIC No::*

Do you give CVDC permission to share your mobile number & email address with other members? :*

Yes

Do you give CVDC permission to use photos of you and your horse(s) for purposes of club promotion (website, posters, Facebook, EA Publications etc)? :*

Yes

I can or my representative can volunteer:*

Are you a current EA member?:*

Yes

What is your EA membership number?:

Clare Valley Dressage Club

Member Registration

Member Details

Residential Address

Mailing Address

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