Mount Barker Adult Riding Club Membership/Renewal form

1. Fees for 2013/14 riding year (1 Oct – 30 Sep) Riding members: $90 (full year) *No Joining Fee* Non-riding members: $25 Mount Barker Adult Riding ClubMembership/Renewal form Name: _______________________________ Address: _____________________________ _____________________________________ _____________________________________ Ph no: _______________________________ Mobile no: ____________________________ Email : _______________________________ PIC No: ______________________________ (Please notify President if you do not have access to email, as this is the only way we will be registering rallies going forward. We will recommend you “buddy up” with another member. Otherwise it will be your responsibility to contact the Secretary each month to register) Date of Birth: _________________________ Equestrian SA Membership No. _______________ Membership type: Riding ______ Non-Riding _______ Total: $_________ Medical details (who should we contact in an emergency?): Contact name: __________________________ Ph no: __________________ Doctor’s name: __________________________ Ph no: __________________ Do you have any medical conditions we should be aware of? Yes ______ No _______ If “yes”, please specify: __________________________________________________________ Vet’s name: _____________________ Ph no: __________________ (all attempts will be made to contact your preferred vet on your behalf, in an emergency. If we are unable to contact your vet, we will then arrange for the first available veterinary surgeon to attend to your horse) Membership is not valid until approved by the committee. If the application should cause the club to exceed membership limit, you will be placed on the waiting list, and notified as soon as a spot becomes available. Please make sure you are familiar with the Mount Barker Adult Riding Club Handbook, and your responsibilities as a Club Member, as you agree to all rules on signing this membership application. Please note that a condition of your membership is that you make yourself available to assist the Committee at a minimum of one rally during the riding year.** Signature of applicant: ____________________________ Date: _________________________ Please note an EFA disclaimer form must be signed, and your helmet must be checked by a committee member before your first ride. Payment can be made by cash, cheque or EFT (BSB 105-900, Account 171762940, Mt Barker Adult Riding Club). If using EFT, please put your name as the bank reference. **Please indicate below the rallies you are available to assist (circle the month): Oct 2013 Nov 2013 Dec 2013 Jan 2014 Feb 2014 Mar 2014 Apr 2012 May 2014 Jun 2014 Jul 2014 Aug 2014 Sep 2014