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

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Birth Date:

Month Day Year
NRHA Number
Membership Type

Adult $60 - yearly Youth $30 - yearly Day membership $30 Life 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 Name Last Name
Date *

Day Month Year
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 Membership Yearly

$ 30.00 AUD

Adult Membership yearly

$ 60.00 AUD

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

$ 150.00 AUD

Day Membership

$ 30.00 AUD

Life Membership

$ 250.00 AUD

Total

$ 0.00 AUD

Club Membership Registration