Gidgegannup Equestrian Association

2022 Mid Year Membership Enrolment Form

Welcome to Gidgegannup Equestrian Association

Mid year membership $85

Mid Year Membership takes effect from July 1st

EFT Reference Code: (MidMship-Surname)

A signed waiver form must accompany your application

Name
Address
Phone
Email Address:
Facebook Name
Birthday
EWA Membership Number (if applicable)
Type of EWA Membership
GEA Membership
- Mid Year Full Membership $85
Amount paid
Date of transfer
EFT Ref (MidMship-Surname)
Payment Method
- EFT (prefered)
- Cheque
- Money Order
I hereby apply to become a member of Gidgegannup Equestrian Association and confirm that I have read and understand the terms and conditions as outlined in the GEA Information pack. I declare I am 18 years of age or over. I have signed the EWA waiver form.
- Agree
- Disagree
Emergency Contact
Phone
Emergency Contact
Phone
Rider's Medical Conditions (Confidential)
Regular Medications
Allergies (Please specify)
Medicare Number
Private Ambulance Insurance
Rider's Experience (only tick one level)
- Level 1: Walk and trot
- Level 2: Walk, trot and canter, 20m circle
- Level 3: Serpentines, lengthened trot and canter, 15m circle, leg yields, simple changes
- Level 4: Shoulder in and travers in trot, half pass in trot and canter, collected walk/trot/canter, extended walk/trot/canter
Additional Comments Rider Experience
Horse's Name 1
Horse 1 Experience (tick as many boxes as applicable)
- nervous
- green/inexperienced
- walk/trot
- walk/trot/canter
- Used to working in a group
- walk trot canter 20 metre circle, serpentines, working on laterals, simple changes
- established laterals, counter canter, working on flying changes, canter 10 metre circles
Additional Comments Horse 1 Experience
Horse's Name 2
Horse 2 Experience (tick as many boxes as applicable)
- nervous
- green/inexperienced
- walk/trot
- walk/trot/canter
- Used to working in a group
- walk trot canter 20 metre circle, serpentines, working on laterals, simple changes
- established laterals, counter canter, working on flying changes, canter 10 metre circles
Additional Comments Horse 2
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Thank you and welcome to GEA!
Please remember to submit the Waiver and Membership Forms individually.

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PAYMENT DETAILS

Membership form can be completed on line.

EFT Details:

Bendigo Bank

BSB: 633-000 ACCOUNT No: 150137297

ACCOUNT NAME: Gidgegannup Equestrian

EFT Reference Code: (MidMship- Surname)

Thank you to our sponsors

Gidgegannup Equestrian Association

Adult Riding Club

2022 Mid Year Membership Enrolment Form