Clone of Dewhurst Equestrian Club Membership Form 2024/2025

Dewhurst Equestrian Club Inc. New Members Application & Membership Renewal 2025/2026.

Complete the form below to join. Completing the form does not guarantee membership. Membership will be confirmed following the Committee's consideration of your application.
HRCAV Membership #
If new to HRCAV please state "new".
Name

First NameLast Name
E-mail
Phone Number:

Area CodePhone Number
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Birth Date:

MonthDayYear
Working with Children's Check Card Number & Expiry Date
If you don't hold a WWC Check please say N/A
Have you been referred by current or past member? If so, who?
I

Emergency Contacts
Emergency Contact 1 Name

First NameLast Name
Emergency Contact 1 Relationship
Emergency Contact 1 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 2 Name

First NameLast Name
Emergency Contact 2 Relationship
Emergency Contact 2 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Ambulance Member
Please list any medical conditions, allergies or medications. If none, state N/A
Car make, colour, model and rego
Float make, colour and rego
Address where horse is kept

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Horse vet name and number

Membership Type	Quantity	Price
Senior Member		$87.00 AUD
Non Riding Member		$28.00 AUD
Associate Member (second club)		$0.00 AUD
Junior Member		$87.00 AUD
Pro-Rata Fee (post 1 August)		$0.00 AUD

	Quantity	Price
Senior Member		$103.00 AUD
Non Riding Member		$22.00 AUD
Associate Member (second club)		$0.00 AUD
Junior Member		$53.00 AUD
Pro-Rata Fee (post 1 August)		$0.00 AUD

	Quantity	Price
Senior Member or Associate Member		$95.00 AUD
Junior Member		$95.00 AUD
Non Riding Member		$10.00 AUD
Pro-Rata Fee (post 1 August)		$47.50 AUD

	Quantity	Price
Magazine		$120.00 AUD
Online		$0.00 AUD

Dewhurst Equestrian Club Inc. New Members Application & Membership Renewal 2025/2026.