Club Membership Registration Form

Club Membership Registration

Complete the form below to become a finacial member of ORHA. Family Memberships can be submitted together on this form. Individual memberships will need to be completed and submitted separately eg: 2 x adults.
Name

First NameLast Name
E-mail
example@example.com
Phone Number:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date:

MonthDayYear
NRHA Number
Membership Type

Adult $60 - yearlyYouth $30 - yearlyEvent membership $15Life Membership $250
Family Membership - yearly (2 adults & 2 youth) $150

Family Membership - Additional member details.

Liability Waiver

Exclusion of Certain Rights to Sue
Signature of Participant*

Clear
Print Name*

First NameLast Name
Date*

DayMonthYear
Date
Signature of Legal Guardian (if participant is U/18)

Clear
Once you submit your application, we will contact you shortly to complete your membership application. Thank you!

Payment*

Youth MembershipYearly

$30.00AUD

Adult Membershipyearly

$60.00AUD

Family Membership2 Adults & 2 Youth (under 18) - yearly

$150.00AUD

Event Membership

$15.00AUD

Life Membership

$250.00AUD

Total

$0.00AUD

Club Membership Registration