1. YOUR NAME

Please insert your correct current name.

Membership must be in the name which you wish to use as the owner of any horse which you may purchase or breed.

2. PARTNER NAMES

If partnership or joint membership list full names of all partners.

3. YOUR ADDRESS

Please insert your correct and current address

4. YOUR EMAIL

Please insert your email address

5. YOUR PHONE NO.

Please insert phone numbers at home, work, mobile and if available your fax number.

6. DATE OF BIRTH

If Youth Membership please state Date of Birth.

PLEASE NOTE: Youth Membership is offered to persons 18 years of age and under as of 1st August in the preceding year.

Youth Members may only own two (2) horses, neither of which can be a stallion.

7. AUTHORIZATION

If applicable, please add the full name of the person who is authorized to sign documents on behalf of this membership.

PLEASE NOTE: This authorized person must be over 18 years of age.

8. ADDITIONAL
    AUTHORIZATION

If applicable, please add the full name of the additinal person who is authorized to sign documents on behalf of this membership.

Please tick
"Both/all signatures required on all documents"
or
"Either signature required on all documents"

9. CONSTITUENT    
MEMBERSHIP

For constituent memberships state full name of person authorized to vote on behalf of this membership. Click here for more info about Constituent Memberships.

PLEASE NOTE: List one (1) name only of a person over 18 years of age.

10. MEMBERSHIP PASSWORD

The Membership Password is to be quoted when wishing to amend membership details over the phone.

11. MEMBERSHIP TYPE

Please select one (1) membership type.

Click here for more info Membership Types.

12. PRIVACY STATEMENT

Please select if my/our contact details can be made available to other members.

13. PAYEMENT DETAILS

Please enter your payment details. Payments can be done by

- attached cheque
or
- Bankcard
- Mastercards
- Visa
For payments by Bankcard, Mastercard or Visa please provide complete card number, expiry date, name on card and your signature.

14. YOUR SIGNATURE(S)

All parties listed above must complete the Membership Application with full name, signature and current date.

With your signature you agree to abide by the Constitution and the Rules and Regulations of the Australian Quarter Horse Association as determined from time to time. Note: Article 11 of the Association provides that all annual subscriptions shall become due and payable on the first day of August each year. New members joining after February 1 and prior to July 31 in any year, pay half of the full membership fees as shown above. Overseas members are asked to remit in Australian currency.

Further, you declare to have read, understood and agreed on the terms and conditions of the Member Acknowledgement printed on the reverse of this Application For Membership.

You understand and agree that the results of any genetic testing facilitated by the Australian Quarter Horse Association on your behalf is and remains the property of the Association for its use in its absolute discretion.

16. HORSE EXPERIENCE

Please select your horse experience as follows

- Very experienced participant/competitor
- Noice participant/competitor
- Never participated/competed

16. MEMBER
ACKNOWLEDGEMENT(S)

All parties listed above must complete the Membership Acknowledgement 2006-2007 with full name and current date