D'Entrecasteaux Pony Club

Member Registration

Member Details

Residential Address

Mailing Address

Other information

Membership Category?:*
PCT Member Number:*
Parent/Guardian details (Junior & Associate members ONLY):
NAME of Parent/Guardian 1:
ADDRESS of Parent/Guardian 1:
MOBILE of Parent/Guardian 1:
EMAIL of Parent/Guardian 1:
NAME of Parent/Guardian 2:
MOBILE of Parent/Guardian 2:
EMAIL of Parent/Guardian 2:
Horse/Riding Details (Junior & Associate members ONLY):
Name of Primary Horse/Pony:
Age:
Height:
Colour:
How long have you been riding this horse?:
Does your horse have previous pony club experience? Please provide details:
Riding Experience: :
Please provide information on previous riding experience, ie have you had regular lessons and if so, with whom? Have you been a member of any other Pony Club?:
Main contact person at pony club events:*
When was the rider's last tetanus injection given?:*
Is the rider allergic to any drugs?:*
If yes, please give details and action plan:
Does the rider have any allergies other than drugs?:*
If yes, please give details and action plan (ie jack jumpers, peanuts):
Does the rider have any other medical problems?:*
If yes, please provide details:

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.