Online Membership Application – Credit Card only Membership Application - Credit Card only Version 1 - 7 July 2021 Please note this form uses conditional logic. Choices made as you progress will reveal or hide additional fields that need your input. Because of this it is best to work from the top down.Your age* 18 Years and over 16 to 18 years Membership type* Riding Member $85 ATA Tentpegging Riding Member $60 Non-riding Member $60 Donation $5 Title* Name* First Last Address* Street Address Address Line 2 City State Postcode Mobile Phone Home Phone Email Date of birth*DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Occupation Riding Applicants Details - if applicable Please include your experience, years riding and any further details to assist your application.Riding Experience level - if applicable Experienced / Competitor Recreational Novice / Beginner Horse details - if applicableBlack, Brown, Bay & Chestnut. No Stallions or Rigs permittedRider / Non-rider sectionRe-enactment Troopif applicable Firearms Details - If applicablePermit Number State Expiry Date Day Month Year General questionsReason for applicationeg: interest in military history etcI am a member of the following organisations / related interestsif applicableMember DeclarationYour full name* I hereby apply to become a member 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 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* Reset signature Signature locked. Reset to sign again 16 to 18 year old member declarationParent/Guardian details - where applicableName Dr.MissMr.Mrs.Ms.Prof.Rev. Title First Last Address Street Address Address Line 2 City State Postcode Applicants Signature 16 to 18 year old only Reset signature Signature locked. Reset to sign again Parent/Guardian Signature for 16 to 18 year old only Reset signature Signature locked. Reset to sign again Your declaration must be done in hardcopy form. Please download hard copy, complete and have your parent or guardian sign NominationsWE HEREBY NOMINATE THE ABOVE MENTIONED CANDIDATE AS A MEMBER OF THE ALHA LTD AND IN DOING SO BELIEVE THE CANDIDATE IS IN EVERY RESPECT ELIGIBLE ACCORDING TO THE RULES AND FIT FOR MEMBERSHIPProposer (1) Member No Troop Proposer (2) Member No Troop Total $ 0.00 Membership does not take effect until your application has been received, passed and bank clearedPaymentI will pay by* Credit Card Cheque/Money Order - Payable to The Australian Light Horse Assoc. Cheque/MO Mail To: Membership Registrar. PO Box 6184 QUEANBEYAN NSW 2620 Payment must be included with or made at time of Application. Direct Deposit - The Australian Light Horse Assoc. Branch: BSB 704 640 Account Number: 32006425 Please include Name Credit CardCard Details Cardholder Name
