SERC Highland Branch | membership form

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SERC Highland Membership Application 2012
Page 1 of 5 - use BACK/NEXT to complete all pages before SUBMIT
Individual - Family - Horses - Fees/Payment - Sign/Submit
Printing available after submission

Individual Contact Details
* fields required
01 Name*
First Name Last Name
01 Birth Date*
Day Month Year
01 Mobile Number
01 New Member?

new member
01 Rider Grading
31 Dec 2011
01 E-mail

01 Address*

Street Address Line 1
Street Address Line 2
Town/City	County
Postal / Zip Code	Country

01 Are you an EGB member?

EGB member
01 Electronic mail?

NO
01 Payment Method*

SERC Highland Membership Application
Page 2 of 5 - use BACK/NEXT to complete all pages before SUBMIT
Individual - Family - Horses - Fees/Payment - Sign/Submit
Printing available after submission

Family Members
Up to 4 people of which no more than 2 may be adults living at the same address.
02 Name
First Name Last Name
02 Birth Date
Day Month Year
02 Mobile Number
02 New Member?

new member
02 Rider Grading
31 Dec 2011
02 EGB member?

EGB member
03 Name
First Name Last Name
03 Birth Date
Day Month Year
03 Mobile Number
03 New Member?

new member
03 Rider Grading
31 Dec 2011
03 EGB member?

EGB member
04 Name
First Name Last Name
04 Birth Date
Day Month Year
04 Mobile Number
04 New Member?

new member
04 Rider Grading
31 Dec 2011
04 EGB member?

EGB member

SERC Highland Membership Application
Page 3 of 5 - use BACK/NEXT to complete all pages before SUBMIT
Individual - Family - Horses - Fees/Payment - Sign/Submit
Printing available after submission

Horse Details
If more than 4 horses, contact administrator >>
01 Horse Name
Registered Name
01 Stable Name (if different)
common or nick name
01 Type/Breed
01 Colour
01 Year Foaled
01 Gender
01 Novice?

01 Novice
01 Horse Grading
31 Dec 2011
01 LogBook No.
02 Horse Name
Registered name
02 Stable Name (if different)
common or nick name
02 Type/Breed
02 Colour
02 Year Foaled
02 Gender
02 Novice?

02 Novice
02 Horse Grading
31 Dec 2011
02 LogBook No.
03 Horse Name
Registered name
03 Stable Name (if different)
common or nick name
03 Type/Breed
03 Colour
03 Year Foaled
03 Gender
03 Novice?

03 Novice
03 Horse Grading
31 Dec 2011
03 LogBook No.
04 Horse Name
Registered name
04 Stable Name (if different)
common or nick name
04 Type/Breed
04 Colour
04 Year Foaled
04 Gender
04 Novice?

04 Novice
04 Horse Grading
31 Dec 2011
04 LogBook No.

SERC Highland Membership Application
Page 4 of 5 - use BACK/NEXT to complete all pages before SUBMIT
Individual - Family - Horses - Fees/Payment - Sign/Submit
Printing available after submission

Fees & Payment

Membership Fees Calculator (Excel spreadsheet)>>

Payment by cheque or banking online - details after submitting application
Riding Adult - £30
Junior Adult - £20
Family - £50
Non-ridiing member - £5
Competitive rider reg. - £10
Log Book purchase - £10
TOTAL

SERC Highland Membership Application
Page 5 of 5 - use BACK/NEXT to complete all pages before SUBMIT
Individual - Family - Horses - Fees/Payment - Sign/Submit
Printing available after submission

Signing & Sending
Please type your full name and tick to indicate your agreement to the constitution and rules of the club before printing / submitting the membership form. This is the same as signing.
1st Adult Name*
1st Signature Date*
- Day - Month Year
1Constitution & Rules*

AGREE
2nd Adult (family ) Name
2nd Signature Date
- Day - Month Year
2Constitution & Rules

AGREE
Data Protection: information on this form will be held on computer and used for the purpose of calculation of awards and performance. This data will not be disclosed to any other organisation without your consent.

Print Form first - before Submit Form . Next page will give payment, bank and contact details. A detail email and pdf application link will be sent.

If Form does not Submit, check *required fields have been completed above.
Should be Empty:

Page Last Updated - 16/02/2012

© SERC Highland