Clubs

Member
Family
Emergency Contact
Other Info.
Merchandise
Fees
Terms / Conditions
Process Payment

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

PIC No. Should be 2 letters & 6 numbers. PIC No. are a legal requirement, your membership will be cancelled if not correct.
PIC No. (Must be 2 letters & 6 numbers for membership to be accepted) *
MCDC has an official photographer, if you don't wish to have your picture used please tick
Do you have a current first aid certificate? *	YesNo

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.

Mt Crawford Dressage Club Inc.

Member Registration

Member Details

Residential Address

Mailing Address

Other information