Draft form page MEMBERSHIP Renewal 2020/2021 MEMBERSHIP RENEWAL / Waiver(1 July 2020 – 30 June 2021) Riding, Non- Riding and ATA Members Membership Renewal Version 5 -5 July 2021 Your age* 18 Years and over 16 to 18 years Membership Number* Troop* AHLA Members DetailsMembership type* Riding Member $85 ATA Tentpegging Member $60 Non-riding member $60 Personal DetailsTitle* Name* First Last Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address* Street Address Address Line 2 City State Postcode Mobile Phone Home Phone Email Member DeclarationYour full name* By renewing my membership of the Australian Light Horse Association Ltd* I agree to abide by the Rules and Regulations of the Association (Available on our website.) I declare that the details I have provided regarding my personal information are true and correct. I acknowledge that Membership does not include Personal Accident Insurance. I understand that the Public Liability insurance only covers Members in Australia and other nominated locations (as stated in the policy) engaging in Light Horse activities. The renewal cycle for the Association is from the 1st of July to the 30th June the following year and pro rata rates do not apply. Copies of the Association magazine "Spur" will be forwarded to the above address each year. I acknowledge that horse sport is dangerous and that accidents causing death, bodily injury, disability and property damage can, and do happen. I acknowledge the inherent risk associated with horses and equine activities. I acknowledge and agree that neither ALHA nor “the organizers” shall be under any liability for death, or bodily injury, loss or damage which may be sustained or incurred by the applicant, as a result of participation in or being present at ALHA endorsed events, except in regard to any rights I may have arising under the Trade Practices Act or State Laws. I acknowledge that I have read and understood the information provided in this membership form and on the ALHA website regarding codes of conduct, training and presentation. Agreed Applicants Signature*16 to 18 year old Member DeclarationYour declaration must be done in hardcopy form. Please download hard copy, complete and have your parent or guardian sign PaymentI am paying by - this form is for Credit Card Only :* EFT Cheque Credit Card Cheque/Money Order -Payable to The Australian Light Horse Assoc. Cheque Mail To: Membership Registrar. PO Box 6184 QUEANBEYAN NSW 2620 Payment must be included with or made at time of Renewal Direct Deposit - The Australian Light Horse Assoc. Branch: BSB 704 640 Account Number: 32006425 Please include Name and number Total $ 0.00 Membership does not take effect until your renewal has been received and bank clearedCredit CardCard Details Cardholder Name NameThis field is for validation purposes and should be left unchanged.