GVSJC Application for Membership

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Goulburn Valley Show Jumping Club Inc. subscription is for 2018-2019 (April 1 to March 31)
Please contact Lindy Bruce 0427 260 442 with any inquiries.

First Name *

Surname *

Address *

Mobile phone number *

Email address *

Membership *

1. Family $125 (max. 5 members at same address; 2 votes for 16yos and over)

2. Adult rider $75 (over 25yos; 1 vote)

3. Junior rider $55 (Under 25yos; 1 vote)

Ref No. for payment made via Direct Debit BSB 633 108: Acc 1464 73343 *

If Option 1: Names of other family members *

Do you have ambulance cover? *

Yes

Required

Ambulance Membership Number *

I/we have private insurance through membership? *

Equestrian Vic

HRCAV

PCAV

Other:

Required

Membership Number *

I/we hereby agree to abide by the rules and regulations of the club: *

Yes

Required

* Please note the committee has the right to refuse or cancel memberships at their discretion. A waiver MUST be signed before membership is valid. Any questions?

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