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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

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Fax No.

Other information

Are you a EA member? *	YesNo
If "Yes", provide EA Member number. If "No", please type "n/a" *
EA Membership catergory *
Is your horse registered with Equestrian Australia/Equestrian Tasmania? *	YesNo
In case of accident please contact *
Relationship: *
Phone: *
Individual JT Membership category? *

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.

Jumping Tasmania - South

Member Registration

Member Details

Residential Address

Mailing Address

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