Kumeu Western Riding Club Membership Form.

Kumeu Western Riding Club

MEMBERSHIP FORM 1 June to 31 May
APPLICATION DETAILS
MEMBERSHIP TYPE
NAMES

(For family membership please list all family names - max 2 adults & 2 children)
Primary Adult Name

First NameLast Name
Adult Name

First NameLast Name
Youth Name

First NameLast Name
Please Select
Youth Name

First NameLast Name
Please Select
Returning Member - No Change
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Riders Email
example@example.com
Second Family members Email
example@example.com
Phone/Mobile

Area CodePhone Number
Add my name to the Facebook Messenger chat group? (Financial member KWRC Communication only)
Emergency Contact

First NameLast Name
Relationship
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone/Mobile

Area CodePhone Number
Any existing medical conditions we should know about
Do you have any objection to your name/photo being posted on our Facebook page or website
PAYMENT METHOD
Signature:
Dated

DayMonthYear
Date
Please Note: Family memberships are entitled to one voting right per membership at club meetings and the AGM, regardless of the number of family members included in the membership. Social memberships do not carry any voting rights.
I/We hereby agree to abide by the Constitution and Rules/Regulations of the Kumeu Western Riding Club, as available from the Committee at kwrc.nz@gmail.com.
(For youth membership only this form must be signed by a parent or guardian)
Should be Empty:

Kumeu Western Riding Club

APPLICATION DETAILS

NAMES

Signature: