Clubs

Membership Category*

Title

First Name*

Last Name*

Date Of Birth*

Email*

Alternate Email1

Address*

Suburb*

Country

State*

Post Code*

Mobile*

EA Member Number

Note: Family Membership Fee includes One Riding Parent/Guardian & up to 2 Children U19 years.

All members must assist at events. *

I agree to my childs photo being used for NAGs benefit. *

Yes

I agree to abide by the code of conduct listed below *