BHPC Membership Application Form 2023

Brookfield Horse and Pony Club Inc.

ABN: 94 711 488 538 PO Box 61 Kenmore 4069
BHPC Membership Application Form 2023
Steps to join or renew membership

Step 1: Before you proceed with this application form, please go to the PCA JustGo portal to join or renew your pony club membership for insurance and affiliation purposes. Pay membership fees as set out, by credit card through the portal. You will be required to provide the payment reference number further down below on this form to be able to finalise your BHPC membership for 2023.

We have included a step by step user guide to navigate the JustGo portal below. Please read or download the user guide as the site can be difficult to navigate.
JustGo User Guide
Step 2: Fill out and submit this BHPC Membership Application(s) with payment of levys as necessary and the annual $50 maintenance levy. Membership applications must be approved by the BHPC Management Committee and applicants will be advised of ratification.

Membership Term

Membership is from 1 Jan to 31 Dec 2023.

Membership Types explained

Riding Instructors or Trainee Instructors must instruct at four musters or other BHPC events to qualify for the discounted fees.

Each family must have at least one parent / guardian who is either a Riding member or Social Member. If the applicant is aged 18 years and over, with no younger family members applying for membership, this is not required.

Part Time membership is available to riders as per BHPC Rules:

These members may attend a maximum of three musters, and all clinics and camps.
They are not required to complete Club Rosters or lodge a Club Roster Levy.
They have to pay their Show Roster Levy, and complete their roster at the Show.

Please contact the membership secretary if you have any questions regarding memberships on 0413 208 083 or memberships@brookfieldponyclub.org.au

Fees

Club Roster Levy $150

Include the Club Roster Levy if you are a new family* OR if your family forfeited the 2022 Club Roster levy. If your family did not complete all your rosters in 2022, add the make-up amount advised by the Treasurer.

The Club Roster Levy is rolled over into the following year if you complete your required rosters/ working bees.

Club roster levy is not applicable to part time riders.

Brookfield Show Levy $150

Families are required to work 6 hours in the BHPC Canteen during the Brookfield Show. Include the Brookfield Show Levy if you are a new family, or if your family forfeited the 2022 Show Levy. This Levy is rolled over into the following year if you complete your shifts at the Show. Please note that BHPC canteen workers are required to pay an entrance fee at the Brookfield Show. You may prefer to join the Brookfield Show Society or become a member for the weekend.

Annual Family Maintenance Levy $50

This is required to cover increasing maintenance and insurance costs for the Rita O’Hanlon arena, the Long yard and equipment.

Departing Families

Families who leave the club may receive a refund of their show Levy and roster levy. BHPC will attempt to contact the family using the provided contact details. However if no response is received by 28 February the following year, it will be considered a donation to the club.
BHPC Membership Form
Please enter you Payment Reference Number that is located on your payment confirmation (received via email) from the JustGo portal*
Please ensure you fill the form in from the top and do not skip fields as the form follows conditional logic to populate fields and provide you with a better user experience
Are you/your family new to club?*

YesNo
Are you interested in a full time or part time BHPC membership?*

Full time (select full time if you are applying for a instructor or trainee instructor membership)Part time
Please select the option that describes your membership requirement the best:*

Riders under the age of 18 and no parent/guardian will be a riding memberRiders under the age of 18 and at least one parent/guardian that will be a riding memberRider(s) 18 years or overNon-riding Instructor or Trainee Instructor 18 years or overRiding Instructor or Trainee instructor 18 years or overRiding Instructor or Trainee instructor under the age of 18 with no parent/guardian a riding memberRiding Instructor or Trainee instructor under the age of 18 with at least one parent/guardian that will be a riding member
Please select the option that describes your membership requirement the best:*

Part time rider(s) 18 years or overPart time riders under the age of 18 and at least one parent/guardian that will be a riding memberPart time riders under the age of 18 and no parent/guardian will be a riding member
How many riding members do you want to register (excluding social members)?*

Rider 1
Rider 1 Details*

Surname Rider 1Given Name(s) Rider 1
Rider 1 Date of Birth*

DayMonthYear
Date
Pony Club ID Rider 1 (existing members only)*

Rider 2
Rider 2 Details*

Surname Rider 1Given Name(s) Rider 2
Rider 2 Date of Birth*

DayMonthYear
Date
Pony Club ID Rider 2 (existing members only)*

Rider 3
Rider 3 Details*

Surname Rider 3Given Name(s) Rider 3
Rider 3 Date of Birth*

DayMonthYear
Date
Pony Club ID Rider 3 (existing members only)*

Rider 4
Rider 4 Details*

Surname Rider 4Given Name(s) Rider 4
Rider 4 Date of Birth*

DayMonthYear
Date
Pony Club ID Rider 4 (existing members only)*

Rider 5
Rider 5 Details*

Surname Rider 5Given Name(s) Rider 5
Rider 5 Date of Birth*

DayMonthYear
Date
Pony Club ID Rider 5 (existing members only)*

Rider 6
Rider 6 Details*

Surname Rider 6Given Name(s) Rider 6
Rider 6 Date of Birth*

DayMonthYear
Date
Pony Club ID Rider 6 (existing members only)*

Please provide your Instructor Blue Card number*
Expiry Date*

MonthDayYear
Date
You have selected a membership that requires a social membership. How many social members do you want to add?*

Only 12

Social Member 1
Social Member 1 Details*

Surname SM 1Given Name(s) SM1
Social Member 1 Date of Birth*

DayMonthYear
Date
Social Member 1 Pony Club ID/Membership nr (existing members only)*

Social Member 2
Social Member 2 Details

Surname SM2Given Name(s) SM2
Social Member 2 Date of Birth

DayMonthYear
Date
Social Member 2 Pony Club ID/ Membership nr (existing members only)

Member over 18, Parent or Guardian Details
Member (if 18 years or over) or Parent / Guardian (1)*

Surname Parent 1Given Name(s) Parent 1
Member (if 18 years or over) or Parent / Guardian (1)*
Please enter a valid phone number Parent 1
Member (if 18 years or over) or Parent / Guardian (1) Email Address 1*
example@example.com
Parent / Guardian (2)

First Name Parent 2Last Name Parent 2
Parent/ Guardian 2 Phone Number
Please enter a valid phone number Parent 2
Parent / Guardian (2) Email Address 2
example@example.com
Who is the primary family contact?*

Member (if 18 years or over) or Parent / Guardian (1)Parent / Guardian (2)Other - Please enter first name, last name and phone number
Addresses for Club Correspondence*

Postal Address Line 1

Postal Address Line 2

CityState/Territory

Post Code
Do you consent to photos of your children appearing on the BHPC website or other club correspondence or publications.*

I consent to photos being posted on BHPC website and other club correspondenceI DO NOT consent to photos being posted on BHPC website and other club correspondence
Are you happy to receive club communication via email?*

Yes, I want to receive club communication via emailNo, please do not send me any club communication via email
Horse Ownership and Biosecurity Information
- The club must be informed if any of the details for the horses included in this form change during the year.
- PIC: Property Identification Code of the property where the horse is usually kept. If you keep your horse at multiple locations please specify all PIC numbers. For information go to https://www.daf.qld.gov.au/animal-industries/moving-selling-livestock/national-livestock-identification-system/property-registration
- Hendra Virus:
  - Horses must be vaccinated against the Hendra Virus (refer By-laws). A horse must have been given the first two Hendra vaccinations at least 21 days before attending its first muster or any BHPC club events held at Brookfield to ensure full immunity.
Please complete horse ownership and biosecurity information*
Please upload a Hendra vaccination certificate for each horse listed. *

To find a copy of your Hendra certificate copy and paste this URL in to your browser: https://www.health4horses.com.au/health-care/conditions/hendra/hendra-registry-lookup.aspx?ReturnUrl=/index.aspx
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Are the horse/horses included above owned or leased?*

All horses are ownedAll horses are leasedSome horses are leased
Please provide the details below for leased horses*
Is the owner a member of BHPC?*

YesNo
*If a horse is leased and the owner is not a member of BHPC both parties must complete and submit Form PCAQ-39 Horse Lease. You can download the form below.
Please download and complete this form. You need to upload the completed form as part of this membership submission. We cannot progress your submission until this form is completed.
Completed Form PCAQ-39 Horse Lease *

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Club Roster Details

Each Family is required to do:
- 4 muster rosters during the year (2 Setup and 2 Canteen rosters) OR 5 Setup rosters for lead line members only; AND
- 2 working bee / fundraising rosters (Specific Dates to be advised).
Note: Work in the Brookfield Show Canteen is additional to and separate from these Club Rosters.

A fee may be charged (refer By-laws) if members do not attend nominated rosters or provide an agreed replacement. If families wish to be considered for exemption from Club Rosters in 2023, they must apply in writing to the BHPC Committee. Limited exemptions are available, and please note the Club Roster Levy will be forfeited.

The Roster Schedule will be made available at the start of the year for each family to nominate their roster commitments.
Payment

Debit or credit card payments coming soon, please pay via direct bank transfer:

Brookfield Horse & Pony Club

BSB 633 000

A/c 151922457

Please use Surname and Initials of Primary parent in the reference/description space when using EFT.

Membership calculation - please select all options that are relevant to your membership. Please note that all members new and existing should select nr. 3*

	Yes	No
1. New Members 2023 - Full Time only members Club Roster Fees (do not tick if you are a part time member)
2. New Members 2023 - All new members please select - Show Roster Levy (both part time and full time)
3. All Members existing and new members family maintenance Levy (excluding instructors)
4. Instructors only

Top up required from last year - Please check to ensure you fulfilled all your volunteering requirements from last year. If you are unsure please contact Rebecca Arnott at admin@brookfieldponyclub.org.au. If you know the amount you agreed to top up, please enter it below.
Please contact Taraneh Khoo at memberships@rookfieldponyclub.org.au or Rebecca Arnott at admin@brookfieldponyclub.org.au if you have any queries about the top up
Total Payable
Date of EFT*

DayMonthYear
Date
Please upload proof of payment

Cancelof
Date*

DayMonthYear
Date
Print Name*
Signature*

Clear
Should be Empty:

Brookfield Horse and Pony Club Inc.

BHPC Membership Application Form 2023

Steps to join or renew membership

Membership Term

Membership Types explained

Fees

Departing Families

BHPC Membership Form

Please ensure you fill the form in from the top and do not skip fields as the form follows conditional logic to populate fields and provide you with a better user experience

Horse Ownership and Biosecurity Information

*If a horse is leased and the owner is not a member of BHPC both parties must complete and submit Form PCAQ-39 Horse Lease. You can download the form below.

Club Roster Details

Payment