Membership Application – Lancefield Equestrian Group

(*Optional) FEES FULL YEAR
*Chaff Chat in paper form $70
** Chaff Chat on Line $30.00

Lancefield Equestrian Group (LEG) Inc

(formerly called Romsey and District Adult Riders (RADAR) )

MEMBERSHIP APPLICATION/RENEWAL FORM 2019/2020

Please pay Lancefield Equestrian Group (LEG) Inc

PO Box 85, Lancefield 3435

Preferred Payment: by Electronic Transfer:
Account Name: Lancefield Equestrian Group
BSB: 633 000
Account No: 118 806 991
In the Description Your Name and Membership No

Please fill in all information and submit form below

Name*
First Last
Address*
Street Address Address Line 2 City State Post Code
Phone*
Email*
HRCAV CARD NO.
If Member of another Club, which Club:
In Case of Emergency
Date of Birth*
Date Format: MM slash DD slash YYYY
Emergency Contact Name*
Emergency Contact Number*
Allergies/Medication being taken, or any health problem the club should know.
Membership Type*
Select your Membership type - Fee structure is outlined below. Please note that if you are a current HRCAV Member, the HRCAV Levy does not apply.
Chaff Chat*
Select whether you would like Chaff Chat included - Fee structure is outlined below.
PRIVACY CLAUSE:
Are you happy for the HRCAV to supply your name and address details to any HRCAV sponsor?
- Yes
- No
I agree:*
That all fields are true and correct and that by submitting this form I agree to all terms and conditions as set out by Lancefield Equestrian Group inc.
- Yes
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