|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
APPLICATION - AFFILIATED INSTRUCTOR
|
|
|
|
|
|
Term of Application
|
|
|
|
|
|
|
Applicant Details
|
|
|
|
Name
|
|
|
|
|
Address 1
|
|
|
|
Address 2
|
|
|
|
Suburb
|
|
|
|
Postcode
|
|
|
|
Email
|
|
|
|
Mobile Phone
|
|
|
|
|
|
|
Club Membership:
|
|
|
|
I am a member of the following Affiliated Club
(list main Club only):
|
|
|
|
|
|
Qualifications
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Background: Details to appear on A.E.C. Website
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
I hereby agree to abide by the Constitution,
Policies and the Rules and Regulations
|
|
|
|
|
|
of the Albany Equestrian Centre Inc, and I am aware
these are available on
|
|
|
|
|
|
the Centre's website
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1 January - 31 December
|
|
|
|
|
|
|
Members
|
|
|
|
|
|
|
Non-Members
|
|
|
|
|
|
|
1 July - 31
December
|
|
|
|
|
|
|
Members
|
|
|
|
|
|
|
Non-Members
|
|
|
|
|
|
|
Total Fees Due
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Your Application will not be accepted without
payment of the above fee
|
|
|
|
|
|
|
|
|
|
|
|
|
Direct Transfer
|
|
|
|
|
|
|
Account Name
|
Albany Equestrian Centre Inc
|
|
|
|
|
|
BSB
|
633-000
|
|
|
|
|
|
Account Number
|
143217743
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Horse Sports
are a Dangerous Activity
|
|
|
|
|
|
I understand that by submission
of this application form, I state that I have read and understand this
Declaration, full particulars of which are available on the A.E.C. website
at:
|
|
|
|
|
|
www.albanyequestrian.net/Waiver%20-%20Events%20-%2022%20Dec
|
|
|
|
|
|
(including the risk
warning, indemnity, release and waiver) and agree to the terms and conditions
as stated.
|
|
|
|
|
|
I understand the Albany Equestrian Centre accepts no liability
for the loss of, or damage to, vehicles, or any other goods or articles, and
does not offer any personal
insurance.
|
|
|
|
|
|
I understand
and acknowledge that horse sports are a dangerous activity and
|
|
|
|
|
|
that horses
can act in a sudden and unpredictable way, especially if
|
|
|
frightened or hurt.
|
|
|
I understand
and acknowledge that serious INJURY or DEATH may result from
|
|
|
horse sport
activities and in particular from events/activities in which I
participate.
|
|
|
I agree that
I PARTICIPATE at my OWN RISK.
|
|
|
Name
|
|
|
|
Date
|
|
|
|
|
|
|
Should you wish to include a photograph on website,
email it to:
|
|
|
[email protected]
|
|