APEC Membership Application Form.pdf

ADELAIDE PLAINS EQUESTRIAN CLUBINCORPORATEDMEMBERSHIP APPLICATION FORMSurname:First Name:Date of Birth:Address:Contact Phone Number:Email Address:Emergency Contact Name& Relationship:EmergencyPhone Number:ContactPIC No for location wherehorse is kept:AHSA (or affiliate of AHSA)Membership No. (ifapplicable)Membership Type:-Foundation Member(only available for first 3 yrs following incorpn)Honorary Member(available for maximum period of 24 hrs, must be nominated)Adult Rider Ordinary (18 yrs & over) Junior Rider Ordinary (under 18 yrs)Adult Social (18 yrs & over)Junior Social (under 18 yrs)Family Membership (please complete a membership form for each Family Member and attach together)Casual (available for maximum period of 24 hrs)(Refer attached Schedule of Fees – these are subject to review annually)Please turn over and complete and sign form

Areas of particular interestPlease identify up to five areas of interest, ranking these from 1 (most interested) to 5 (least interested of top 5).This will assist the Committee to take into consideration all members interests in scheduling activities.Learn to rideLearn basic dressage/Come and Try DressageHorse Health and WellbeingHorse Education TechniquesHorse Property ManagementDressageShow - JumpingShow - HackingEventingEndurance RidingLearn to jump/Come and Try jumpingTrail RidingGames (Bending etc)Barrel RacingPolo/PolocrosseHorse Drawn/HarnessWestern - Reining and CuttingWestern - PleasureCampdrafting and Team PenningOther – please specifyBreed Specific Activities – pls identify breedInsurance RequirementsAs a member of the APEC, you are required to have, as a minimum, public liability insurance. You may already havesuch insurance with the insurance company with whom APEC holds its insurance policy and therefore may alreadyhave in place the required insurance. This may include Arabian Horse Society of Australia (AHSA) or an affiliate ofAHSA.Please identify if you have an existing Public Liability policy as a rider with an insurer as follows:-Policy Number Policy Type and Coverage Insurer Name of InsuredPersonAPEC will advise you if it’s insurance policy is held with this insurer. It is your responsibility to confirm with yourinsurer that you are covered by this insurance policy whilst participating in any APEC activities and events and toprovide such confirmation in writing from your insurer to APEC.Confirmation and AcknowledgementI confirm that all information contained in this Member Application Form is true and correct and acknowledge that Imust have in place appropriate insurance as a rider prior to participating in any APEC activities or events involvingriding and/or harness driving or being a harness passenger.I further acknowledge that I must comply with the Constitution of the APEC and all other policies and proceduresestablished by the APEC Committee from time to time. Failure to do so may result in the cancellation of mymembership, for which I acknowledge that I may forfeit any membership fee paid.Signed:Date:_______________________________________ (Member Applicant)_______________________________________Agreed: _______________________________________ (Parent/Guardian if Member Applicant is under 18)Parent/Guardian Name: ________________________________ Parent/Guardian Ph No: _____________________