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Title*

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Last Name*

Date Of Birth*

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Alternate Email1

Alternate Email2

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Address*

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** (Please see conditions of membership for juniors in the waiver below)

I am hereby applying for Membership of the Australian Horseball Association Inc (AHBA) and agree to abide by the Rules and Regulations of the Association as well as the Code of Conduct. I am also aware that acceptance of my membership is subject to my signing of the Liability Waiver included on my membership application.

Parent/Guardian required for Junior Membership

Parent/Guardian name

Parent/Guardian number

Do you hold a First Aid Certificate? *

Yes

If yes, please note expiry date

Do you hold a current Blue Card *

Yes

If yes, please note expiry date

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.

Australian Horse Ball Association

Member Registration

Member Details

Residential Address

Mailing Address

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