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for the year ended 31 December 2023
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Membership Type
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Friend of the AEC Membership
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Member's Name
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Surname
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Given Names
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Date of Birth(if under 18)
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Parent/Guardian Name (if
Member under 18 years)
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Surname
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Given Names
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Contact Details
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Address 1
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Address 2
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Suburb
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Postcode
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Mobile Phone
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Home Phone
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Work Phone
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Email
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I hereby agree to abide by the Constitution,
Policies and the Rules and Regulations
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of the Albany Equestrian Centre Association.
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Fees Due:
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Friend of the A.E.C. Membership
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Membership Discount
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Total Fees Due
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Your Membership will
not be accepted without payment of the above fee, and expires on 31 December
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Direct Transfer
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Account Name
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Albany Equestrian Centre Inc
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BSB
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633-000
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Account Number
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143-217-743
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Payment Receipt Details
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Date
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Amount
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Receipt Number
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Reference
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Horse Sports
are a Dangerous Activity
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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:
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www.albanyequestrian.net/Waiver%20-%20Events%20-%2022%20Dec
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(including the risk
warning, indemnity, release and waiver) and agree to the terms and conditions
as stated.
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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 to riders.
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I understand
and acknowledge that horse sports are a dangerous activity and
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that horses
can act in a sudden and unpredictable way, especially if
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frightened or hurt.
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I understand
and acknowledge that serious INJURY or DEATH may result from
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horse sport
activities and in particular from events/activities in which I
participate.
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I agree that
I PARTICIPATE at my OWN RISK.
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Name
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Date
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Third party indemnity where participant is under 18
years of age
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I,
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being the parent/guardian of the nominated Member, hereby
acknowledge through the submission of this allication form:
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·
I consent to the Member participating in the
Equestrian Activity.
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·
I am aware of the risks, dangers and obligations
set out in the E.A. Waiver of Events (2022) document.
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I acknowledge that the Rider is bound by and
subject to the rules, regulations, guidelines, policies and codes of conduct
of EA and the Albany Equestrian Centre.
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In consideration of the nominated Member being accepted as a
Member I hereby indemnify and release the Organiser/s and the Associate/s in
the same manner and to the same effect as if I was the Member and agree to
personally accept all terms and conditions and obligations set out in this
declaration.
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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 to riders.
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AGREEMENT ON BEHALF OF ONE PARENT OR GUARDIAN IS AGREEMENT ON
BEHALF OF ALL PARENTS AND/OR GUARDIANS OF THE RIDER.
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Parent/Guardian
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Date
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