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Membership Category:*

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:*

Post Code:*

Work Phone: Ext:

Fax No.:

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PIC Number::*

HORSES HEALTH DECLARATION Section will appear on ALL EVENT Waivers. This MUST be completed at the time of Entering. You will need to put Name of Event & Date of the LAST Event your Horse Attended within the previous 3 months.:

I will complete a horse health declaration for evey event I attend:*

What Kind of Equine Event are you interested in?:*

Dressage

Fun Days

Hacking

other

Western

If other, please specify:

Club Event Photography:

I give permission for the use of photographs containing any of the members listed for us on Valley Equestrian Club Facebook Page and website www.valleyequestrian.net:*

Yes

Valley Equestrian Club Kempsey

Member Registration

Member Details

Residential Address

Mailing Address

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