GOULBURN VALLEY EQUESTRIAN CLUB INC.

NEW MEMBERSHIP / RENEWAL FORM 2017/18

24 Granthorn St, Shepparton 3630 (Membership Secretary Faye Jasper: 0409 338 377
PO Box 6563 Shepparton 3632 )

Name: ______________________________________

Address: ______________________________________

______________________________________Post code_____________

Phone: (H) _______________ (W) _________________(M)_________________

Email: __________________________________________________________
(Please print email details clearly)

Date of Birth:_______________________ HRCAV Membership/ship No___________

(If under 18 years)

MEMBERSHIP FEES 1st Nov 2017 31st Oct 2018 (please circle appropriate fees)
GVEC HRCAV HRCAV TOTAL Chaff Chat Must be
FEE FEE INS completed
Senior/
Associate $60.00 $57.88 $67.12 $185.00 Chaff Chat can
member be ordered on
Junior/ line at
Associate $60.00 $57.88 $28.52 https://hrcav.co
$146.40 m.au/
GVEC Social
(non-riding $1.00 $12.95 $14.05 $28.00
member)
TOTAL PAYABLE - cheque enclosed payable to GVEC OR Total
- directly to Bank: BSB 083 894 Account No: 15-132-9970
Membership not accepted until signed forms & payment received by Membership Secretary.

I, the undersigned, hereby make application for membership or renewal to the Goulburn Valley
Equestrian Club. (please circle correct application)
I am fully aware of, and agree to adhere to, the rules, regulations and requirements of the Goulburn
Valley Equestrian Club, the Equestrian Australia and the Horse Riding Clubs Association of Victoria
and all decisions of the committee.
I realise that there is an obligation to support club activities and help with fund raising ventures. I
understand that the annual subscription falls due on 31st October each year and I am required to be
a member of the Horse Riding Clubs Association of Victoria (HRCAV).

Signature: ______________________ Date: _______________

Are you happy for the HRCAV to supply your name and address details to any HRCAV sponsor?

YES / NO (please circle) Signature: ___________________________

Are you happy for the GVEC to provide newsletters and general communication via email?

YES / NO (please circle)

Are you happy that photographs / information about yourself & your horse may appear in the GVEC newsletter and website?
YES / NO (please circle)

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