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Club Member
Club Administration

Somersby Equestrian Club

Member Registration

Member
Family
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Other Info.
Merchandise
Fees
Terms / Conditions
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Membership Category:*

Please select membership category

Member Details

Title:

First Name:* Please enter first name

Last Name:* Please enter last name

Date Of Birth: Please enter a valid date

Sex:

Email:* Please enter email Invalid email

Alternate Email1: Invalid Email

Alternate Email2: Invalid Email

Residential Address

Address:

Suburb:

Country:

State:

Post Code:

Home Phone:

Mobile:* Please enter mobile

Mailing Address

Address:* Please enter address

Suburb:* Please enter suburb

Country:

State:* Please select state

Post Code:* Please enter post code

Work Phone: Ext:

Fax No.:

Other information

Rider FEI:

Rider EA:

Occupation:

Financial:

If you are under 18, please advise your Parent/Guardians name and contact details (if not under 18, please put NA):*

Please enter a valid date Required field is missing

I understand that it is a condition of membership that I contribute at least one day per year of voluntary work for the Club:*

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Yes I would love to help out with::

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Gear Check:*

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Yes

Required field is missing

Pencilling:*

Please enter a valid date

Yes

Required field is missing

Scoring:*

Please enter a valid date

Yes

Required field is missing

Running/General Duties:*

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Yes

Required field is missing

Horse 1 Name:

Please enter a valid date

Horse 1 Bridle Number:

Please enter a valid date

Horse 1 EA Number (owner/rider):

Please enter a valid date

Horse 1 EA Number:

Please enter a valid date

Horse 2 Name:

Please enter a valid date

Horse 2 Bridle Number:

Please enter a valid date

Horse 2 EA Number:

Please enter a valid date

Horse 3 Name:

Please enter a valid date

Horse 3 Bridle Number:

Please enter a valid date

Horse 3 EA Number:

Please enter a valid date

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?

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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