Reining Australia & Affiliate Clinic Approval Form
Clinic Approval Forms to be submitted minimum 45 days prior to Event
Clinic Information
Name of Affiliate Hosting Clinic
*
Please Select
SQRHA
MRR
SCWHA
QRHA
SNSWRHA
TRHA
WARHA
WCR
RA - GB
FROM DATE
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
TO DATE
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Type of Clinic
*
Reining
Ranch Riding
Dry Work Phase of Challenge
Mechanical Cow
Youth Camp
Other
Other detail:
Address of Venue
*
Event Co-ordinator/s Contact Information
2 different contacts required for Clinic Approval
CONTACT 1 - Name
*
First Name
Last Name
Reining Australia Membership #
*
Contact Number
*
Please enter a valid phone number.
Format: 0000-000-000.
Email Address
*
example@example.com
CONTACT 2 - (NOT TO BE THE SAME AS ABOVE) Name
*
First Name
Last Name
Contact Number
*
Please enter a valid phone number.
Format: 0000- 000-000.
Reining Australia Membership #
*
Email Address
*
example@example.com
Detailed Costs per Participant
Please submit $$ value to the following 8 categories
*
Clinician/s Information
Please Add each Clinician individually by +Add Row
*
PLEASE NOTE ALL CLINICIANS BEING REMUNERATED (Paid) MUST HAVE A CURRENT CERTIFICATE OF INSURANCE (Public Liability for Training)
UPLOAD Clinician Certificate of Insurance individually per paid Clinician
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