Tri Valley Equitation Inc.

Member Registration

Member Details

Residential Address

Mailing Address

Other information

Please indicate your level of riding experience and/or equestrian qualifications:*
What are you able to help the club with?:*
What do you hope to achieve?:*
Medical Information:
Medicare Number:*
Private Health Number:
Doctor/Phone:*
Do you, or have you ever suffered from any illnesses or allergies?:*
If yes, please detail:
Do you have any medical conditions that may require a health management plan?:*
If yes, please detail:
Are you currently on any medication?:*
If yes, please detail:
Do you have a neurological disorder?:*
If yes, please detail:
Have you had, or do you have?:
Epilepsy:*
Hepatitis A:*
Hepatitis B:*
Asthma/Bronchitis:*
Hernia:*
Spinal Injury:*
Concussion:*
Diabetes:*
Head Injury:*
If yes, please detail condition and plan:
Do you give permission for images or video taken at any Tri Valley Equitation event to be used by Tri Valley Equitation for:*

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.