CLUB USE ONLY Application / Club Championships / HAVE YOU PREVIOUSLY BEEN A MEMBER OF A PONY CLUB / /
IndustryTerm
public liability insurance cover / bank deposit transaction / bank account / bank cheque / protective equipment / insurance cover / insurance broker / web site www.pcaq.asn.au / /
Organization
Management Committee / Pony Club Association of Queensland / ANY ILLNESSES OR ALLERGIES WHICH MIGHT AFFECT YOUR ACTIVITIES AT PONY CLUB / CALOUNDRA PONY CLUB INC / Caloundra Pony Club / Pony Club Association of Queensland Inc. / Pony Club / Pony Club Association of Queensland Codes of Behaviour Policy / Pony Club Association of QLD Inc / PRIVATE HEALTH FUND / FROM ANY ILLNESSES OR ALLERGIES WHICH MIGHT AFFECT YOUR ACTIVITIES AT PONY CLUB / MEDICARE / /
Position
CAN THE DENTIST / representative / Yes/No Protective Equipment Yes/No Diabetes Yes/No Mouth Guard / Secretary / insurance broker / No DENTIST / lawyer / /
CALOUNDRA PONY CLUB INC[removed]APPLICATION FOR CLUB MEMBERSHIP (Separate form for each applicant) FULL NAME OF APPLICANT: __________________________________________________________________________