MEMBERSHIP APPLICATION 2012
(return to PO Box 241, Pomona 4568)

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

MEMBERS FIRST NAME:
1...……………………………………..  D.O.B. ……./……./…….  Social/Pedestrian/Riding

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

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

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

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

…………………………………………………………………………………………………..

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

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

* EMAIL IS USED TO KEEP YOU UP TO DATE WITH PONY CLUB NEWS, IT IS YOUR RESPONSIBILTY TO ADVISE THE SECRETARY WHEN ANY OF YOUR DETAILS CHANGE.

*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        $ 95.00    (   )               2 riders per family                   $180.00   (   )

3 riders per family       $255.00   (   )               4 riders per family                   $320.00   (   )

Social Member            $  38.00   (   )              Pedestrian Equestrian              $  68.00   (   )  
 Additional riding members per family-$65 per person

Club Worker Assistance Levy  $100.00 (COMPULSORY PER FAMILY – INFORMATION RELATING TO THE 5 WAYS TO EARN THE CLUB LEVY BACK ARE ON FOLLOWING PAGE. BESURE TO FAMILIRISE YOURSELF WITH THE REQUIREMENTS.)

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.  

CLUB WORKER ASSISTANCE LEVY

This is a refundable fee at the end of the year providing 10 hours of assistance is met by any of the following; Your hours must be signed off by committee:-

1. take up a committee position/ instructor role; 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)
5. take on and perform club role (eg. Nominations, newsletter etc)

Members are expected to help set up & pack up equipment at musters if riding/participating at musters – this DOES NOT contribute towards the club levy, as it is expected that all help who participate.

If a family chooses NOT to meet the above obligations then no refund will be given.

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

1………………………………………..                                          ………………………….
Signature of Member or Parent/Guardian                                           Date

2………………………………………..                                          ………………………….
Signature of Member or Parent/Guardian                                           Date

3………………………………………..                                          ………………………….
Signature of Member or Parent/Guardian                                           Date

4………………………………………..                                          ………………………….
Signature of Member or Parent/Guardian                                           Date