2020 Membership Application: Online Form
P.O. Box 372 Stn "C"
St. John's, NL A1C 5J9
www.equestriannl.ca

Effective January 1-December 31, 2020

Please fill out all fields, INCLUDING the digital signature at the bottom, and click submit when complete. Memberships are valid when funds are confirmed as accepted by the NLEA treasurer.

For questions relating to completing this form, please email secretary@equestriannl.ca
Applicant Name *
Date of Birth *
MM
/
DD
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YYYY
Gender *
Previous NEA Membership Number (if applicable)
Mailing address (this is where your membership card will be sent) *
Email address *
Phone Number *
Alternative Phone Number
Additional Members
Each member will be issued a separate membership number. For insurance purposes, you must include Name, Relationship, Birth Date and previous membership number if known.
Membership Fees (please check all that apply) *
Required
NLEA Optional Insurance Program
Horse & Pony Magazine
Total Amount Due: *
Payment is accepted by cheque, cash, or e-transfer to treasurer@equestriannl.ca. Memberships are non-refundable. Please make cheques payable to: Newfoundland & Labrador Equestrian Association. If sending an etransfer, please use the password: NLEA2020 (case sensitive). In the space below, please indicate the total amount due for your membership(s):
Statistical Information
This information is collected to assist the NLEA in future program and service development, grant applications, government reporting, and focus areas.
Industry Participation (Please select all that apply):
Primary Discipline (Please select all that apply):
Special Interests (Please select all that apply):
The following information is MANDATORY to process memberships. Please check, where applicable, and provide consent:
Electronic Communication Consent: Please read the following statement, and indicate your agreement by checking the box. *
Volunteer: Would you like to hear about NLEA volunteer opportunities throughout the year?
Clear selection
Parental Consent: If there are Junior Members included in this application, this section MUST be filled out.
MANDATORY ELECTRONIC SIGNATURE REQUIRED
I, the undersigned, hereby declare the information provided in this application to be true and accurate. Falsifying information could possibly null and void insurance in the event of a claim. (Please print name of applicant, or parent/legal guardian of Minor applicants): *
By checking this box, I certify that my electronic signature is binding: *
Required
BENEFITS OF MEMBERSHIP
IMPORTANT INSURANCE INFORMATION

The Descriptions of coverage have been prepared for information purposes only.
The insuring agreements, general terms, conditions and exclusions of the actual policy will govern specific application of the various coverages referred to herein. In all cases the actual policy documents will supersede these descriptions. Please be advised a nominal administrative fee is collected by the NLEA for all optional insurance purchased.
The insurance coverage included and / or available as an option with your Newfoundland Equestrian Association Membership is provided to you by Intercity Insurance Services Inc.
The NLEA is not licensed to sell or provide counsel on the insurance coverage.

Please contact Intercity Insurance directly for any questions regarding coverage, limitations or exclusions at 1-888-394-3330 (Equine Department).

AUTOMATIC INSURANCE PRODUCT DESCRIPTIONS

$5,000,000 Personal Liability Insurance ($1000 Property Damage Deductible)
Protects you, the member, if you are sued by a third party because a horse that you own or lease, ride or
Handle non-commercially, causes property damage or bodily injury to a third party. **Liability coverage is for non-commercial equine related activities. Some limitations and exclusions apply. Coverage is in force, 24 hours a day, seven days a week, and covers the member (Canadian Resident) anywhere in the world. (Exclusions apply for members who are non-Canadian residents)

$30,000 Accidental Death & Dismemberment Coverage
Covering you, the member, should you suffer a catastrophic injury, dismemberment or death arising from equine related activities. (Under the age of 90 and only available to Canadian Residents)




OPTIONAL INSURANCE PRODUCT DESCRIPTIONS

NLEA Optional Accidental Death & Dismemberment INCLUDES Fracture and Dental Benefits (ADD) 2020- $40.00
$50,000 -Enhanced Accident, Death and Dismemberment for injuries sustained by you, the member related to horses, including coverage when you are en route to and from an equine activity in a vehicle. This policy will pay regardless of any other insurance that may be in force at the time of the incident.
*Enhanced AD&D is restricted to members who have not reached the age of 75 years

NLEA Members Named Perils 2020 -$25.00
$10,000 –Horse Mortality (Named Perils). Horse(s) you own are covered for death arising from Fire, lightning, transportation, earthquake or flood, attack by dogs or wild animals. Limit of $10,000 any one loss and any one term. Includes compensation for government ordered destruction of horse. This policy must be purchased by the owner of the horse(s).

NLEA Members Tack 2020 - $50.00
$10,000 –Tack and Equipment - Insurers tack and equipment from loss or damage anywhere in Continental US/Canada. Tack and horse equipment you own, excluding rider clothing and protective equipment is insured against loss or damage from "all risks". Limit of coverage is $10,000 for any one loss, total limit per term. Losses subject to deductible of $500.00

Travel (out of Province/Country) Coverage -Member Only 2020 –
Travel insurance is available to members of any age, once you have purchased your NLEA membership you will be provided with a link in which you can purchase travel insurance. Travel insurance is customized to your individual requirements.

***Please note that the optional insurance does not come into effect until Jan 1st, 2020.
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