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Membership Category*

Member Details

Title*

First Name*

Last Name*

Date Of Birth*

Sex*

Email*

Alternate Email1

Alternate Email2

Residential Address

Address*

City/ Town*

Country

Province

Postal Code*

Home Phone

Mobile*

Mailing Address

Address*

City/ Town*

Country

Province

Postal Code*

Work Phone Ext.

Fax No.

Other information

Are you a Certificate Examiner *

Yes

If Yes at What Level

Do you coach at Pony Club? *

Yes

If Yes at What Level

Ethnicity - Choose from the following options *

Membership Registration

Rider fee includes: 1st Rider 2nd Rider

Puketapu PC $50.00 $ 0.00

Heretaunga PC $55.00 $45.00

HB Area PC $35.00 $35.00

NZPCA $40.00 $40.00

Email address is already assigned to a member,
please use an alternative email address.

You appear to be an existing member.
Do you want to renew your membership?

Primary member must be over 18 years of age.

Aged pension membership is for members over 65 years.
Please choose another membership type or correct your date of birth.

EA number does not match member name.

To be eligible for this membership, a doctors certificate/para classification/RDA associate membership must be provided to the club to receive a code to apply for this membership type. Please type code in below.

Heretaunga-Puketapu

Member Registration

Member Details

Residential Address

Mailing Address

Other information

Membership Registration