Clubs

Member
Family
Emergency Contact
Other Info.
Merchandise
Fees
Indemnity
Process Payment

Member Details

Membership Category:*

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:

Work Phone:

Ext.

Fax No.:

Other information

Are you an Equestrian Tasmania Member	YesNo
If yes, are you an Equestrian Tasmania Competitor	YesNo
If yes, are you an Equestrian Tasmania Participant	YesNo
In Case of Accident Name of Contact *
In Case of Accident Relationship of Contact *
In Case of Accident Mobile # of Contact *

Notes

NOTE:
Family membership consists of two parents/guardians (senior riders) and thier one/two children (junior riders)
Please ensure that all names and DOB's are provided for junior family riders.

For membership enquires please message our Facebook page or contact Secretary Bek Dornauf via email rtyler89@gmail.com or phone 0418518115

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 over 18 years of age.

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.

Jumping Tasmania North

Member Registration

Member Details

Residential Address

Other information

Notes