POMONA PONY CLUB

MEMBERSHIP APPLICATION 2011

(return to PO Box 241, Pomona 4568)

FAMILY NAME:  …..…………………………………………………………………...……

MEMBERS FIRST NAME:

………………………………………..  D.O.B. ……./……./…….  Social/Pedestrian/Riding

………………………………………..  D.O.B. ……./……./…….  Social/Pedestrian/Riding

…………………………………..……  D.O.B. ……./……./…….  Social/Pedestrian/Riding

…………………………..……………  D.O.B. ……./……./…….  Social/Pedestrian/Riding

ADDRESS:  …………………………………………………………………………………….

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HOME PHONE:  …………………………      MOBILE:  ……………………………………

EMAIL:  ……………..………………………………………………………………………...

*IT IS A REQUIREMENT FOR THOSE RIDERS UNDER 18 YEARS OF AGE TO HAVE A PARENT OR GUARDIAN AS A SOCIAL, PEDESTRIAN EQUESTRIAN OR RIDING MEMBER OF THE CLUB AND FOR THE PARENT OR GUARDIAN TO BE PRESENT AT ALL PONY CLUB EVENTS WHILE THE JUNIOR RIDER IS MOUNTED.  THE JUNIOR RIDER WILL BE ASKED TO DISMOUNT AND TIE THEIR HORSE UP IF THESE REQUIREMENTS ARE NOT MET.
 
*IT IS A REQUIREMENT FOR THOSE PARENTS OR GUARDIANS HELPING A RIDER ON A LEAD REIN TO BE A PEDESTRIAN EQUESTRIAN OR RIDING MEMBER.

Cost (Please tick which is applicable):

1 rider per family        $ 87.00    (   )               2 riders per family                   $164.00   (   )
3 riders per family       $231.00   (   )               4 riders per family                   $288.00   (   )
Social Member            $  30.00   (   )              Pedestrian Equestrian              $  60.00   (   )

Additional riding members per family-$57 per person

Compulsory Club Worker Assistance Levy  $100.00 (per family)

All subscriptions listed above include PCAQ levies including insurance and a Pomona Pony Club membership fee.

Please Note: A $2 per rider muster fee applies at every muster attended.  

COMPULSORY CLUB WORKER ASSISTANCE LEVY

This is a one off fee refundable on cancellation of membership providing you have met your obligations in providing 10 hours of assistance every calendar year by a combination of any of the following:-

1. take up a committee position; or
2. attend and participate at working bees throughout the year; or
3. working in the canteen; or
4. assistance at club events throughout the year. (i.e. set up, assist at the event, and take down)

If a family chooses NOT to meet the above obligations then an additional $100 levy will be payable with membership fees in the following year

This summary sheet is to be returned to the Club with the PCAQ Indemnity form and PCAQ Application for Club Membership

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Signature of Member or Parent/Guardian                                           Date

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Signature of Member or Parent/Guardian                                           Date

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Signature of Member or Parent/Guardian                                           Date

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Signature of Member or Parent/Guardian                                           Date