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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

Emergency Contact Details

Emergency Contact Name *

Emergency Contact Number *

Emergency Contact Relationship *

Are you an EA Member? *

Yes

If yes, please list EA Member number

If yes, what is your EA Membership Level?

Volunteer Preferences

Would you be willing to assist at the club events (eg, penciling, scoring, setup)?. *

Yes

If yes, preferred areas?

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.

Wisemans Dressage Association

Member Registration

Member Details

Residential Address

Mailing Address

Other information