Cooloola Dressage Association Inc

Member Registration

Member Details

Residential Address

Mailing Address

Other information

Emergency Contact Name *
Emergency Contact Number *
Do you have any medical conditions? *

If other, please describe:
In the event of an emergency, I give permission for medical treatment to be administered. *
It is compulsory that all members assist at club activities. Please indicate below where you can assist our club. *

If you are an EA member enter your EA number

Email address is already assigned to a member,
please use an alternative email address.

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Aged pension membership is for members over 65 years.
Please choose another membership type or correct your date of birth.