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Membership Category*

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

Work Phone Ext.

Fax No.

Other information

Do you have Ambulance Cover? *

Yes

PIC No: *

Do you give CVDC permission to share your mobile number & email address with other members? *

Yes

Do you give CVDC permission to use photos of you and your horse(s) for purposes of club promotion (website, posters, Facebook, EA Publications etc)? *

Yes

I can or my representative can volunteer *

Are you a current EA member? *

Yes

What is your EA membership number?

Clare Valley Dressage Club

Member Registration

Member Details

Residential Address

Mailing Address

Other information