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Membership Category*

Member Details

Title

First Name*

Last Name*

Date Of Birth

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

Optional - riding ability

Optional - interests

Optional - horse details

In the event of an accident, an ambulance may be required. I agree to meet all costs associated with medical care while on club activities *

Are You Also a Member of EA? *

Yes

Do You Hold a Current First Aid Certificate *

Yes

If yes, please provide EA number

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 an Adult/18+. Children/under 18 memberships can be added on the next page.

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.

Bungendore Riding Club

Member Registration

Member Details

Residential Address

Mailing Address

Other information