RVPC Membership & Renewal Form

River Valley Pony Club Membership & Renewals
BEFORE YOU BEGIN PLEASE REVIEW & CHECK OFF THE FOLLOWING ITEMS:

COGGINS: Make sure you have access to an electronic copy of your horse's coggins for uploading to this form PARENTS: Please fill this out WITH your child present so you can review the Code of Conduct portion with them FEES: Make sure that you are able to pay membership dues with PayPal at the end of this form. If Paypal is not an option for you, please email us for a paper/mailed check version of this form. FAMILIES: We need a separate form on file for each member.

Member Info
Member's Full Formal Name *
Member's Email *
example@example.com
Member Phone *

Area Code Phone Number
Home Address *
Street, City, State, Zip
Member & Parent have read & understand the River Valley Pony Club Handbook (found on our website) *

YES
I understand that for Members over the age of 18 years old, USPC requires both a favorable background check & participation in SafeSport training. If applicable, I will complete both requirements (at an additional cost that is eligible for reimbursement per club's Special Award form) on the National Pony Club website before I am eligible to participate in River Valley PC activities *

Yes I understand

Membership Type
Membership Type *

Traditional Member, Under 25 years of age Adult Membership, Over 25 years

Traditional Membership

Please fill out all fields if member is under the age of 25.
Member Date of Birth *
Mother's Name *
Mother's Phone # *
Mother's Email *
example@example.com
Father's Name *
Father's Phone # *
Father's Email
example@example.com

Adult Membership

Any members over the age of 25 please complete this section
Emergency Contact Name & Phone # *
As an Adult USPC Member, I understand that USPC requires both a favorable background check & participation in SafeSport training. I will complete both requirements (at an additional cost that is eligible for reimbursement per club's Special Award form) on the National Pony Club website before I am eligible to participate in River Valley PC activities. *

Clear

Riding Experience & Horse Info

All members fill in the section below
Trainer/ Lesson Barn
Pony club is not a replacement to a regular lesson program. Members are expected to regularly work with an equine professional even if their horse is kept at home. This assures the member is able to work on the pony club riding curriculum with correct feedback on safety & jumping. If you need a referral or help getting plugged in to the local equine community please ask!
Trainer's ph #
Trainer's Email
example@example.com
I have access to a mount/ trailer for meetings? *

Yes No
Horse(s) Name
Horse Gender

Gelding Mare
Color
Height
Breed
Proof of Negative Coggins Upload *

Browse Files
Keeping your horse up to date on your coggins testing and updating our club with new coggins proof when renewed is required. Cancel of

Pony Club Experience
Let us know your pony club experience level: *

Brand new to Pony Club Renewing/Current Member Rejoining after a lapse in membership longer then 6 months Transferring from another club
Please provide details on previous club & certification level if applicable. If you are brand new to pony club feel free to share your motivation for joining and any other relevant info.

Club Sponsorship
Local Pony Club runs on volunteers & parents. Club officer roles are voted on each year as are important rules, annual budget, fundraisers, & certain aspects of the club calendar.

Officers & Adult Sponsors vote on these decisions in 1-2 Sponsor Meetings per year. Club sponsors must make every effort to attend these meetings.
Sponsorship Level for upcoming year (Sept. 1- Aug 31) *

{ $0} I do not wish to be a club sponsor & waive my voting rights. { $15} I (or one parent of child member) would like to be listed as a club sponsor and attend Sponsor meetings.
Sponsor/Parent Name if applicable

River Valley PC Code of Conduct

is established to clarify RIVER VALLEY PONY CLUB guidelines and expectations for each member.
Member Signature

Member Signature Clear

Membership Fees

Please select the fees that correspond to your membership status & renewal timing.
My Products
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River Valley Annual Membership $ 70.00
This covers your membership to RVPC ($50), which is a branch of U.S. Pony Club and to Carolina Region ($20). If you select this option, you MUST also complete your renewal to USPC before participating in RVPC activities.

New USPC Member Free
USPC National Membership: Depending on the join date, new USPC member dues range from $155-$200, PAID DIRECTLY TO USPC when you receive email invite. You will be sent a separate email invitation to complete your national joining process. This RVPC membership form AND the USPC membership process/payment must be complete before being able to participate in activities that involve being on our near a horse.

Optional Club Sponsorship $ 15.00
Include this fee to be added as a voting club sponsor. See form Sponsorship question for more details.

Renewal Late Fee $ 20.00
This fee must be added to your renewal if you were a member of the previous year and are renewing after Dec 31st

Total $ 0.00
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River Valley Pony Club Membership & Renewals