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Membership Category*

Member Details

Title

First Name*

Last Name*

Date Of Birth*

Sex*

Email*

Alternate Email1

Residential Address

Address*

Suburb*

Country

Post Code*

Home Phone*

Mobile

Mailing Address

Address*

Suburb*

Country

Post Code*

Work Phone Ext.

Other information

Are you a Certificate Examiner *

Yes

If Yes at What Level

Do you coach at Pony Club? *

Yes

If Yes at What Level

Ethnicity - Choose from the following options

Leamington Pony Club membership notes

For more information and details about Leamington Pony Club visit our Facebook page. Enquiries can be made there as well.

*Must contribute to club either on committee, as a coach or volunteer.

Email address is already assigned to a member,
please use an alternative email address.

You appear to be an existing member.
Do you want to renew your membership?

Primary Member must be an Adult/18+. Children/under 18 memberships can be added on the next page.

Aged pension membership is for members over 65 years.
Please choose another membership type or correct your date of birth.

EA number does not match member name.

To be eligible for this membership, a doctors certificate/para classification/RDA associate membership must be provided to the club to receive a code to apply for this membership type. Please type code in below.

Cambridge-Leamington

Member Registration

Member Details

Residential Address

Mailing Address

Other information

Leamington Pony Club membership notes