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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

What Certificate Level do you currently have?

Are you a Certificate Examiner

Yes

If Yes at What Level

Show Name of your Horse/Pony

Paddock Name Of your Horse/Pony

Do you hold a current First Aid Certificate

Yes

Date of birth of you Horse/Pony

Do you coach at Pony Club? *

Yes

If Yes at What Level

Ethnicity - Choose from the following options *

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.

Motueka-Motueka

Member Registration

Member Details

Residential Address

Mailing Address

Other information