Yorke Peninsula Equestrian Club Inc

Member Registration

Member Details

Residential Address

Mailing Address


Other information

PIC Number *
Emergency Contact
Name *
Relationship to Rider *
Contact Number *
Have you any conditions / ailments the club should be aware of? Are you taking any medication we should be aware of?
If yes, please provide details:
Do you hold a current First Aid Certificate?
Do you consent to your image being used on the club website, Facebook page and other promotional materials? (If this is not ticked, we will assume Yes)

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?

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