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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*

City/ Town*

Country

Province*

Postal Code*

Home Phone*

Mobile*

Mailing Address

Address

City/ Town

Country

Province

Postal Code

Work Phone Ext.

Fax No.

Other information

Do you have Ambulance Cover? *	YesNo
PIC No: *
Do you give CVDC permission to share your mobile number & email address with other members? *	YesNo
Do you give CVDC permission to use photos of you and your horse(s) for purposes of club promotion (website, posters, Facebook, EA Publications etc)? *	YesNo
I can or my representative can volunteer *
I can or my representative can volunteer *
I can or my representative can volunteer *
Are you a current EA member? *	YesNo
What is your EA membership 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 over 18 years of age.

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.

Clare Valley Dressage Club

Member Registration

Member Details

Residential Address

Mailing Address

Other information