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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.:

Other information

Are you an Equestrian Australia/Equestrian Tasmania Member:*

Yes

If yes, are you an Equestrian Australia/Equestrian Tasmania Competitor:*

Yes

If yes, are you an Equestrian Australia/Equestrian Tasmania Participant:*

Yes

In Case of Accident Name of Contact:*

In Case of Accident Relationship of Contact:*

In Case of Accident Mobile # of Contact:*

Is your horse registered with Equestrian Australia/Equestrian Tasmania?:*

Yes

Notes

NOTE:
Family membership consists of two parents/guardians (senior riders) and thier one/two children (junior riders)
Please ensure that all names and DOB's are provided for junior family riders.

For membership enquires please contact Secretary Abby via email [email protected] or phone 0439 966 174

Jumping Tasmania North

Member Registration

Member Details

Residential Address

Mailing Address

Other information