Caboolture Dressage Group 2018 Annual Membership Application
(1st January — 31st December)

Electronic transfer to:
Bank of Qld Ltd. Account Name: Caboolture Dressage Group Inc.
BSB: 124-041 Account No: 10337627
Please ensure the reference clearly states: “Your Name / M/Ship”
Please have your payment reference number ready to enter into this form.

Surname *
Your answer
First name *
Your answer
Membership type *
Joining fee (for new and lapsed membership)
Only one fee is payable per family or single membership. Rejoining fee applies for membership renewals received after the 31st January.
Date of Birth *
MM
/
DD
/
YYYY
Are you a junior? *
Address *
Your answer
City *
Your answer
Post code *
Your answer
PIC number *
Your answer
Mobile phone number *
Please use home phone only if you don't have a mobile number.
Your answer
Email *
Your answer
Are you a current EA member? *
If yes, EA membership number
Your answer
Are you a current CDG member? *
If yes, CDG membership number
Your answer
Are you applying for family membership?
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