Membership & Waiver Form

Membership Renewal/Application for Membership – 2016/2017

DATE:______

To:DRESSAGE NSW INC

ABN: 97 482 552 442

PO Box 372, RICHMOND 2753

Upon payment this form will become a tax invoice for GST purposes. All prices include GST

The following information in BLOCK LETTERS please:

Mr/Mrs/Miss/Ms: Surname:
/ Given Names:
Address:
PostCode:
Occupation: / Date of Birth:
Telephone Nos: (BH) STD Code: / (AH) STD Code:
Mobile: / Email:
EA Membership No:
* I intend to compete in the next 12 months as an AdultAmateur Owner/Rider: YES/NO
I have read the AOR guidelines and confirm I met the criteria. YES/NO
please advise DNSWif your status as AOR changes.

AOR: 21yrs and over – can enter in the calendar year in which they turn 21.

OFFICALS Membership Fee: Official membership is for current EA accredited non riding officials and have the same privileges as other Ordinary members.

Existing Members – Renewal / New Membership Application
I wish to renew my membership for: / Fee / I wish to apply for: / Fee
 Ordinary withCentreline / $90.00 /  Ordinary withCentreline / $90.00 + joining fee $20.00 Tot: $110.00
 Junior (under 18 yrs) withCentreline / $90.00 /  Junior withCentreline / $90.00 + joining fee $20.00 Tot: $110.00
 Ordinary Official withCentreline / $60.00 /  OrdinaryOfficialwithCentreline / $60.00 + joining fee $20.00 Tot: $80.00
 Ordinary member NO Centreline / $68.00 /  Ordinary NO Centreline / $68.00 + joining fee $20.00 Tot: $88.00
 Junior (under 18 yrs)NO Centreline / $32.00 /  Junior Membership / $32.00+ joining fee $20.00 Tot: $52.00
 Life Membership / $1495.00 /  Life Membership / $1495.00 + joining fee $20.00 Tot: $1515.00

Please note thatJunior members do not receive Centreline each issue but receive a minimum of 2 issues per year. Junior members who wish to receive a copy of all Centreline publications can join as a junior member with Centreline. Refer above for conditions of Officials membership fees

 ExistingLife Members: I agree to contribute $44 towards the cost of receiving a copy of Centreline. (Optional)
Subscription for Centreline / This is for subscription to magazine only and does not include membership privileges (eg. competition discounts). Includes 6 issues from time of payment.

The Financial Year is from 01 JULY TO 30 JUNE - Membership Fees are subject to Cost of Living Index.

Members joining JAN-JUNneed only pay half-yearly membership to be renewed on 1 July (, ie, $45.00PLUS the joining fee of $20.00 for new members only. = $65.00 ($36 for Juniors no Centerline)

The joining fee applies also to Lapsed Members whose membership has lapsed for more than 3 months.

Dressage NSW Pins (Note: Pin badges are included in the joining fee and sent to all new members at time of joining)

I would like to order ___Pin/badge @ $5.50 each. Tot: $______Please include payment for badges with your renewal/application for membership.

Mailing list: please indicate if you agree to your name going on mailing list to other organizations: (eg.Sponsors/Saddleries etc)
Yes (I agree) No (I don’t) Signature of Applicant: ______

Members of the Equestrian NSW are required to sign a Disclaimer with their membership renewal. This covers all members for ENSW/DNSW sanctioned events.

Credit Card Payments: Paying for DNSW Membership 2016/2017

Please charge my: Visa Master for $______

Card No: ______Expiry Date: ____/____

Full Name on Card: ______Cardholder’s Signature: ______