AHTPA membership form 25/25

Membership Form

25/26Season
Welcome to the AHTPA 25/26 competition season.

The membership year runs from 1st Aug to 31st July .
Member Number - If unsure contact the AHTPA secretary
Member Name *

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Postal Address*

Postal Address

Street Address Line 2

City/TownState

Post code
Birth Date*

DayMonthYear
YesNo
Membership type*
prevnext( X )
Full membership
Full membership allows riders to enter all AHTPA Inc events in the membership year, Full membership is available to members over 18.

$70.00AUD

Junior Membership
Junior membership allows riders to enter all AHTPA Inc events in the membership year, Junior membership is available to members 8 to 18.

$30.00AUD

Total

$0.00AUD
Payment details

Adelaide Hills Team Penning Association

BSB 105 055

Acc # 048 329 140

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.
Emergency Contact

Please provide the below emergency contact details
Emergency contact name*

First NameLast Name
Emergency contact phone number*
Please enter a valid phone number.Format: (000) 000-0000.
Ambulance Membership number
First Name* Last Name* agree to abide by the rules and conditions as set out in the AHTPA Offical member handbook rule s& regulations 2022

Date*Signature*
Should be Empty:

Membership Form