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ACT Dressage Association

Member Registration

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Member Details

Title:

First Name:*

Last Name:*

Date Of Birth:

Sex:

Email:*

Alternate Email1:

Alternate Email2:

Residential Address

Address:

Suburb:

Country:

State:

Post Code:

Home Phone:

Mobile:

Mailing Address

Address:

Suburb:

Country:

State:

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Work Phone: Ext:

Fax No.:

Other information

Occupation:	Please enter a valid date
DOB (if applicable):	Please enter a valid date
NSW Bridle Number (if applicable):	Please enter a valid date
EA Number:	Please enter a valid date
Horses EA registered Name:	Please enter a valid date
Horses EA Registration Number:	Please enter a valid date
Are you happy to go onto our email list to be sent updates of comps & Newsletters:	Please enter a valid date
Please nominate which category you would like to be in for the annual rider awards:	Please enter a valid date
Open Rider:	Please enter a valid date
Amateur Owner/Rider:	Please enter a valid date
Recreational Amateur under 45 yo:	Please enter a valid date
Recreational Amateur 45 and over:	Please enter a valid date
Young Rider:	Please enter a valid date
*Further detail on each category is available in the ACTDA Pointscore Rules located on the Forms and documents page on our website:	Please enter a valid date