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Member Details

Title

First Name*

Last Name*

Date Of Birth*

Sex*

Email*

Alternate Email1

Alternate Email2

Residential Address

Address

Suburb

Country

State

Post Code

Home Phone

Mobile*

Mailing Address

Address

Suburb

Country

State

Post Code

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Fax No.

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Area of Interest

1. Dressage

2. Showjumping

3. Show Horse

Are you a current EA member? *

Yes

Rider EA Number:

Occupation

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 an Adult/18+. Children/under 18 memberships can be added on the next page.

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.

Equestrian Gold Coast Club (EGCC)

Member Registration

Member Details

Residential Address

Mailing Address

Other information