RHASA Season membership form

Welcome to the RHASA 25/26 competition season.

The membership year runs from 1st Aug to 31st July .

New members please complete the below information your membership number will be emailed out once you have pressed submit

Member Name *

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Postal Address*

Postal Address

Street Address Line 2

City/TownState

Post code

Birth Date*

DayMonthYear

Membership type*

Full membershipFull membership allows riders to enter all RHASA events in the membership year, Full membership is available to members over 18.

$60.00AUD

Junior MembershipJunior membership allows riders to enter all RHASA events in the membership year, Junior membership is available to members 8 to 18.

$25.00AUD

Total

$0.00AUD

Payment details

RHASA

BSB 085 005

Acc # 898650279

Payment reference is your membership number (you will receive email with your number once you submit your membership).

Day membership please use your name as reference.

Horse experience -Not limited to riding

1.Very experienced participant/rider2.Novice participant/rider3.Never participated/competed

I consent to RHASA using any pictures of myself or my horse for promoting RHASA.*

YesNo

Association Membership (Are you a member of any other assocition AQHA,PHAA,AAA or similar ?)

Association nameMembership #

Emergency contact name*

First NameLast Name

Emergency contact phone number*

Please enter a valid phone number.

Ambulance Membership number

In consideration for being permitted to participate in any way in horse riding activities I the undersigned, understand, acknowledge and accept that:

Horse riding and participation in horse related activities is/are dangerous recreational activities and horses and cattle can act in a sudden and unpredictable (changeable) way, especially if frightened or hurt.
There is significant risk that serious INJURY or DEATH may result from participating in horse related competition or activities.
I voluntarily PARTICIPATE at my OWN RISK and assume sole responsibility for any injury, death or property damage I may suffer that arises from my participation in horse related activities.
I understand and acknowledge the dangers associated with the consumption of alcohol or any mind altering drugs before and during the activity and I take full responsibility for any injury, loss or damage associated with their consumption. I agree not to drink alcohol or take drugs prohibited by law before or during any horse activity.
I agree to abide by the Rules & Regulations of the Ranch Horse Association of Australia and Ranch Horse Association South Australian Club, its affiliated clubs and/or management/organizer of the activities and that I will follow all directions of the management/organizer of the activities.
My failure or refusal to do so can result in my immediate disqualification from the activities and the forfeiting of all fees paid in relation to the activities.
I understand that any such non-compliance may result in injury, death and/or permanent disability.
RHASA, its affiliated clubs and/or the Management/organizer takes due care to ensure that the venues chosen are safe and suitable, any equipment provided for the purpose of such activities is maintained in good condition and the Association’s/management/organizer’s staff are appropriately trained.
I further confirm that I am in good health and do not suffer from any disability which will affect my ability to participate. I have had sufficient opportunity to read this document, fully understand its terms and sign it freely and voluntarily without inducement of any kind.
In case of emergency I do hereby give my consent for medical treatment to be given by a Doctor and/or Hospital staff, and I Agree to pay all costs associated with emergency transport and treatment should an accident occur during activities conducted by RHASA.

Date*Signature*

New Member

Emergency Contact