PHSSA 26/27 Membership

Paint Horse Soceity SA Member Registration

26/27 Season
Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Email Address
example@example.com
PHAA #
Postal Address

Postal Address

City/TownState Post code
Emergency Contact Name
Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Ambulance membership number

Competitor Jacket size and Horse rug size

Jacket Size Horse rug size
Association memberships (please list )

My Products
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Single Membership
Single membership allow a single rider to enter all PHSSA events in the membership year and is available to people over the age of 18.

$50.00 AUD



Youth Membership
Youth membership allows riders to enter all PHSSA events in the membership year and is available to juniors aged 8 to 18 years.

$35.00 AUD



Constituent Membership

$15.00 AUD



Family Membership
Family membership allow for two adults and two children riders to enter all PHSSA events in the membership year. Junior riders are to be aged between 8 and 18 years.

$65.00 AUD Quantity



Total

$0.00 AUD
Payment details

Account Name: PHSSA

BSB: 105-009

Account Number: 065497140

Please use your name as your payment reference.

I consent to PHSSA using any pictures of myself and my horses for promotional purposes.

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 can act in a sudden and unpredictable 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 agree to abide by the Rules & Regulations of the Paint Horse Association of Australia and Paint Horse Society of South Australia, its affiliated clubs and/or management/organizer of the activities and that I will follow all directions of the management/organizer of the activities.
- 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 PHSSA.
I have read and understand the Hi-Point rules and hereby register for Hi-Points.

Date Signature
Should be Empty:

Paint Horse Soceity SA Member Registration

My Products*

My Products