SQRHA Clinic Form

SQRHA May Clinic Booking Form
May Clinicians are Leanne Bartlett & Jason Wordsworth
Clinic Details: 7am-10am 11th May 2013
Clinic Cost: $60.00
All participants must be a financial member of SQRHA, Day memberships are available.
Fill out your Membership Form Online
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Contact Details
NOK

First NameLast Name
Phone Number

Area CodePhone Number
Declaration

Forms can be printed and mailed to:
The Secretary
60 Sandalwood Avenue South
Dalby. QLD. 4505
Email: kyley.norman@bigpond.com
PH: 0458812309

SQRHA Bank Details
Southern Queensland Reining Horse Association
Bendigo Bank
Account No: 122073281
BSB: 633-000

SQRHA May Clinic Booking Form