G & Hea Adult Riding Division

2018 MEMBERSHIP ENROLMENT FORM

NAME
ADDRESS
CONTACT Tel No / MOBILE No
EMAIL
FACE BOOK NAME
EWA member no:
(if applicable) / Type of EWA membership: / Basic ARCA
Competitor Participant

PLEASE SELECT MEMBERSHIP TYPE:

Type / Fee / Tick
Full / $170
Associate / $120
Family / $310 (2 members)
$150 (per additional person)
Social / $20
Amount Paid: / $ / Date of transfer:
EFT Receipt number: Please insert your Surname-Membership as the payment reference when transacting your payment.
I hereby apply to become a member of the Gidgegannup Equestrian Association and confirm that I have read and understand the terms and conditions as outlined in the GEA information pack.
I declare that I am 18 years of age or over. I have signed that EWA waiver form.
Signature of Member: / Date:

EMERGENCY CONTACT AND MEDICAL INFORMATION (STRICTLY CONFIDENTIAL)

Emergency Contact Name 1: / Contact Ph No 1.
Emergency Contact Name 2: / Contact Ph No 2.
Riders Medical Condition(s) & Regular Medications:
Allergies:
(please specify)
Date of Birth: / Medicare Number:
Private Ambulance Insurance? / Yes No

MEMBERSHIP FEES ARE NON-REFUNDABLE

2018 RIDER/HORSE INFORMATION FORM

RIDER’S NAME:

RIDER’S EXPERIENCE (tick as many boxes as applicable):

Green/ Inexperienced / Walk/Trot / Walk/Trot/
Canter / Pony club / ARC
Dressage Level: (If applicable) / Preparatory
/ Prelim / Novice / Elementary & above
Show jumping: (If applicable): / Beginner (under 50cm) / 50-60cm / 60-75cm / 80+cm
Eventing / Endurance / Games/ agility / Western Riding / Natural Horsemanship
Other:
HORSE’S NAME 1: / AGE:

HORSE’S EXPERIENCE (tick as many boxes as applicable):

Green/ Inexperienced / Walk/Trot / Walk/Trot/
Canter / Pony club / ARC
Dressage Level: (If applicable) / Prep
(or nil) / Prelim / Novice / Elementary & above
Show jumping: (If applicable): / Beginner (under 50cm) / 50-60cm / 60-75cm / 80+cm
Eventing / Endurance / Games/ agility / Western Riding / Natural Horsemanship
Other:
HORSE’S NAME 2: / AGE:
Green/ Inexperienced / Walk/Trot / Walk/Trot/
Canter / Pony club / ARC
Dressage Level: (If applicable) / Prep
(or nil) / Prelim / Novice / Elementary & above
Show jumping: (If applicable): / Beginner (under 50cm) / 50-60cm / 60-75cm / 80+cm
Eventing / Endurance / Games/ agility / Western Riding / Natural Horsemanship
Other:

ANY OTHER INFORMATION YOU CONSIDER RELEVENT TO PLACE HORSE AND RIDER IN THE APPROPRIATE GROUPS: (e.g. horse has never cantered in a group)