Pintos SA Membership Form
Name
*
First Name
Last Name
Previous Membership Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Type of Membership
*
Honorary Life
Stud
Family
Single Adult
Junior
Name of ALL persons to be covered by Membership
*
Name of Nominated Membership Signatory
*
First Name
Last Name
ANNUAL STOCK AUDIT
*
Rows
Horses Name
Registration Number
DOB
Sex
Leased Y/N
Deceased Y/N
I apply for Membership to the Pinto Association of SA Inc. By signing this box, I agree the above submitted information is true and correct.
Payment Options
Credit/Debit Card of Direct Bank Transfer
Direct Bank Transfer Receipt Number
Select Membership Type (For Credit/Debit Payment ONLY)
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Stud Membership
$127.50 AUD
$
127.50
AUD
Family Membership
$113.90 AUD
$
113.90
AUD
Single Membership
$83.00 AUD
$
83.00
AUD
Total
$0.00 AUD
$
0.00
AUD
Credit Card
Submit
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