05/05/2020
APPLICATION FOR MEMBERSHIP Membership –1st July 2020 to 30th June 2021
Fees: (Please tick applicable membership and fee) NEW Single Membership Fee: $70.00
RENEW
RESIGN
SINGLE FAMILY
JUNIOR
PARTNERSHIP SUBSCRIPTION
Post Code:
Mobile:
Details are Confidential: Yes/No
Family Membership Fee: $160.00 (2 adults & 2 children, under 18 years) **Please state birth date of Junior Members** _____/______/______ & _____/______/______
Junior Membership Fee: $50.00 (under 18yrs (Mare-Gelding owners only) **Please state birth date of Junior Member** _____/______/______
Partnership Membership Fee: $130.00 1 voting right
Magazine Subscription: $20.00
Name(s): Address:
Telephone: Email:
Please print clearly
Signature of Applicant(s): _________________________________________________________________________
Please nominate the name of the person entitled to sign documents and vote on this membership: Mr/Mrs/Ms:
Signature:
Please tick if you would like to receive your “Golden Bulletin” magazine by email (Please provide email address)
Please make Cheque/money order payable to the Australian Palomino Horsebreeders Association Inc Direct Deposit: Nab: BSB: 083 894 Account No: 048211587 REF: Membership Name
Membership Fee: $
Late levy of $20.00 if paid after 1st September (Not applicable to New Members) $
TOTAL: $
Application for membership and total fees must be forwarded to the A.P.H.A Administrator PO Box 130, Sunbury Victoria 3429
DON’T FORGET TO FILL IN YOUR WAIVER FORM AND SEND WITH YOUR MEMBERSHIP FORM!!
Australian Palomino Horsebreeders Association Inc.
A0007216F
ABN: 70 637 393 265
APHA Administrator – National Office PO Box 130, Sunbury, VIC 3429 Ph: (03) 9744 3256
Email: [email protected] Web: www.apha.net.au
INDEMNITY & WAIVER - ADULT
This waiver form is to be completed by each member. (For example, a Family membership of four (4) people must complete 4 waiver forms.) Waiver forms must accompany Membership applications.
I, _____________________________________________________________________________________ (print name)
Of ___________________________________________________________________________________ (print address)
Horse Sports are a Dangerous Activity
I understand and acknowledge that horse sports are a dangerous activity and that horses can act in a sudden and unpredictable (changeable) way, especially if frightened or hurt.
I understand and acknowledge that serious INJURY or DEATH may result from horse sport activities. I agree that I PARTICIPATE at my OWN RISK.
I agree not to drink alcohol or take drugs prohibited by law before or during this competition.
Effect of this Document
I understand that my signature to this document constitutes a complete and unconditional release of all liability.
Agree to compete at any APHA Inc. Show or Event at my own risk.
Agree not to make any claim against the APHA Inc. for any injury or loss sustained at any Show or Event.
Agree to compete/exhibit at my own risk and to indemnify and keep indemnified the APHA Inc. together with any other
organisation or person involved in the conduct of any Show or Event against all claims, suits, actions or demands which may be brought in respect of any injury or other loss sustained by me in the course of competing/exhibiting at the Show or Event and agree to exonerate the Committee of Management of the APHA Inc. together with any other organisation or person involved in the conduct of any Show from all responsibility and from all loss or injury to me whether due to alleged negligence or otherwise.
Signature: _______________________________________________ Date: ______________________________
INDEMINITY & WAIVER - UNDER 18 YEARS
This form is to be signed by the parent/guardian of all members under the age of 18 years
I, _____________________________________________________________________ (print name of Parent / Guardian) Of __________________________________________________________________________________ (print address) am the Parent / Guardian of (print name/s) ____________________________________________________________
And I agree that he/she have my permission to compete/exhibit at any APHA Inc. Show or Event subject to the following terms and conditions: -
Agree that he/she will compete/exhibit at any APHA Inc. Show or Event at he/she/their own risk.
Agree not to make any claim against the APHA Inc. for any injury or loss sustained at any Show or Event.
~ Agree that he/she compete/ exhibit at his/her own risk and to indemnify and keep indemnified the APHA Inc. together with any other organisation or person involved in the conduct of any Show or Event against all claims, suits, actions or demands which may be brought in respect of any injury or other loss sustained by him/her in the course of competing/exhibiting at the Show and agree to exonerate the Committee of Management of the APHA Inc. together with any other organisation or person involved in the conduct of any Show or Event from all responsibility and from all loss or injury to him/her whether due to alleged negligence or otherwise.
Signature: __________________________________________ Date: ________________________
INDEMNITY & WAIVER - ADULT
This waiver form is to be completed by each member. (For example, a Family membership of four (4) people
must complete 4 waiver forms.) Waiver forms must accompany Membership applications.
I, _____________________________________________________________________________________ (print name)
Of ___________________________________________________________________________________ (print address)
Horse Sports are a Dangerous Activity
I understand and acknowledge that horse sports are a dangerous activity and that horses can act in a sudden and unpredictable (changeable) way, especially if frightened or hurt.
I understand and acknowledge that serious INJURY or DEATH may result from horse sport activities.
I agree that I PARTICIPATE at my OWN RISK.
I agree not to drink alcohol or take drugs prohibited by law before or during this competition.
Effect of this Document
I understand that my signature to this document constitutes a complete and unconditional release of all liability.
∼ Agree to compete at any APHA Inc. Show or Event at my own risk.
∼ Agree not to make any claim against the APHA Inc. for any injury or loss sustained at any Show or Event.
∼ Agree to compete/exhibit at my own risk and to indemnify and keep indemnified the APHA Inc. together with any other organisation or person involved in the conduct of any Show or Event against all claims, suits, actions or demands which may be brought in respect of any injury or other loss sustained by me in the course of competing/exhibiting at the Show or Event and agree to exonerate the Committee of Management of the APHA Inc. together with any other organisation or person involved in the conduct of any Show from all responsibility and from all loss or injury to me whether due to alleged negligence or otherwise.
Signature: _______________________________________________Date: ______________________________
INDEMINITY & WAIVER - UNDER 18 YEARS
This form is to be signed by the parent/guardian of all members under the age of 18 years
I, _____________________________________________________________________ (print name of Parent / Guardian)
Of __________________________________________________________________________________ (print address)
am the Parent / Guardian of (print name/s) ____________________________________________________________
And I agree that he/she have my permission to compete/exhibit at any APHA Inc. Show or Event subject to the following terms and conditions: -
∼ Agree that he/she will compete/exhibit at any APHA Inc. Show or Event at he/she/their own risk.
∼ Agree not to make any claim against the APHA Inc. for any injury or loss sustained at any Show or Event.
~Agree that he/she compete/ exhibit at his/her own risk and to indemnify and keep indemnified the APHA Inc. together with any other organisation or person involved in the conduct of any Show or Event against all claims, suits, actions or demands which may be brought in respect of any injury or other loss sustained by him/her in the course of competing/exhibiting at the Show and agree to exonerate the Committee of Management of the APHA Inc. together with any other organisation or person involved in the conduct of any Show or Event from all responsibility and from all loss or injury to him/her whether due to alleged negligence or otherwise.
Signature: __________________________________________Date: ________________________
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