MEMBERSHIP APPLICATION / RENEWAL
Including Coaches

I ………………………………………………………………………………………………………………………......................................................
(Please print full name include Maiden name if applicable)

of ………………………………………………………………………………………..............................................................................................…     
(Please print address)

……………………………………………………….............................................……………Post Code ……………………..……..........……….  

Ph: (Home) …………………………………Ph.: (Work) ……………...................…………………Fax…………………....................…………..

Email Address &/or Mobile No.…………………………………………………………………….……….….….........………

Equestrian Centre: …………………………………………………………………………………….......….………………….

Current Qualifications:            ……………………………………………………………………….………….……………….
(Please list and  attach copies of appropriate documents)
………………………………………………………………………………………………………………….........................…….

First Aid Certificate current till:  ……………………..........................………………………………………………………….
(Please attache copy)

I am applying for (please tick applicable box)    o  Membership Renewalo New Membership                 
         * Full Member ($250)                  * Associate Member ($100)          Personal Member ($30)   
*(N.B. No joining fee this year for new Full or Associate Members but they will need to apply for Accreditation).

Payment is made by: (please tick whichever box is applicable – Cheques made out to Australian Horse Riding Centres – Qld)
   Money Order                          Cheque                                 Direct Deposit

Direct Deposit Payment Details:
 
Bank : Bank of Queensland-Kenmore        BSB:     124 196                                   Account No:   2005 5188
(Please attach the direct deposit transaction receipt and attach to this form.)

I have read, understand, agree with, and abide by the current Code of Practice, Rules and Regulations that govern the Equestrian Sport and Australian Horse Council endorsed by the Australian Horse Riding Centre Code of Conduct, Rules and Regulations.

Signed: ……………………………………………………..                 Date: ………………………………................

For Office Use Only – Privacy Act 1998 – AHRC

Members Name: ………………………………………………………….ID Number: …………………………………..

Membership: (please circle whichever appropriate)                      Full                  Associate            Personal     

Amount Received:                ………………………

Processed and signed by: ……………………………………  Signature : ……………………………… ………….
(Please print name here)

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