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First Name*

Last Name*

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Do you suffer from Allergies & or any medical condition? *

Yes

If yes, please provide details of condition & action plan.

Emergency contact information:

Emergency contact name *

Relationship to you *

Emergency contact number *

Horse emergency contact Name *

Horse emergency contact number *

In the event that your horse is injured at an APEC event & you are unable to attend to your horse due to injury to yourself, please advise contact details for your Vet

Veterinarian Name/Clinic *

Veterinarian/Clinic Phone Number *

In the event that APEC is unable to contact your vet, you acknowledge & agree that APEC will seek veterinary attendance, at your cost, from the nearest available vet. APEC will follow the advice of the vet & shall not be held liable, financially or in any way whatsoever, for any such decision. *

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.

Adelaide Plains Equestrian Club (APEC)

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