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Club Member
Club Administration

TeKauwhataDistrict-Waerenga

Member Registration

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Member Details

Title:* Please select title

First Name:* Please enter first name

Last Name:* Please enter last name

Date Of Birth:* Please select date of birth Please enter a valid date

Sex:

Email:* Please enter email Invalid email

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Residential Address

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Suburb:* Please enter suburb

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Post Code:* Please enter post code

Home Phone:

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Mailing Address

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Work Phone: Ext:

Fax No.:

Other information

Rider FEI:

Rider EA:

Occupation:

Financial:

What do you wish to achieve this season at Pony Club?:*

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Are you a Certificate Examiner:*

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Yes

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If Yes at What Level:

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Do you coach at Pony Club?:*

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Yes

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If Yes at What Level:

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Ethnicity - Choose from the following options:*

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Asian

Do not wish to answer

Maori

Middle Eastern/Latin America/Africa

NZ European

NZ Maori European

Other

Pacific Peoples

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Do you want to renew your membership?

Primary member must be over 18 years of age.

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

EA number does not match member name.

To be eligible for this membership, a doctors certificate/para classification/RDA associate membership must be provided to the club to receive a code to apply for this membership type. Please type code in below.

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