2020 GVRHA MEMBERSHIP

GOULBURN VALLEY REINING HORSE ASSOCIATION MEMBERSHIP APPLICATION

Membership Year: 1st January - 31st December 2020
2020 MEMBERSHIP - NEW and RENEWALS
1. Complete form below.
2. Download and sign insurance waiver at end of form and email to: gvrha@outlook.com OR mail to: GVRHA, 328 Reith Road. Wangaratta VIC 3678.
3. Pay membership fee via direct bank deposit to: GVRHA - BSB: 013 870 ACCOUNT: 4958 75895.
New Membership or Renewal of old Membership *
GVRHA MEMBER#
If renewing
Membership Type *

Full Riding $75 Non Riding $25 Youth $35 Life $550

NAME *
DATE OF BIRTH *

Day Month Year
Date Date Picker Icon
STREET *
TOWN *
POST CODE *
PHONE NUMBER *
EMAIL ADDRESS *
Emergency Contact Name *
Emergency Contact Phone Number *

LIABILITY WAIVER
The purpose of this agreement is to limit the liability of the Provider to exclude liability for any personal injury or death to the participant and other people in the care and control of the participant howsoever caused who signed this form as acknowledgement of the terms and conditions of this agreement. By signing this form you are waiving your rights to sue the provider for losses relating to personal injury or death. Under the provisions of the trade practices act and various state laws conditions are implied into contracts that mean that the provider of recreational services, noted below, is required to ensure that the recreational services it sells to you are rendered with due care and skill, are fit for the purpose for which they are commonly bought as it is reasonable to expect in the circumstances or might reasonably be expected to achieve the result you have made known to the provider. Provider name & address:

Goulburn Valley Reining Horse Association
328 Reith Rd
Wangaratta Victoria 3678

The participant acknowledges that during all times while he or she is attending the recreational activity he or she does so at his or her own risk and that the participant and other people in the care and control of the participant will not hold the provider or any of its employees or agents liable for any personal injury or breach of contract whether caused by the negligence of the provider, its employees or agents howsoever caused or otherwise. The participant ackn
owledges that in the event that he or she or any of the other people in their care and control find either or any of them in difficulty that they are to stop the activityor request that the activity be stopped if appropriate, and seek help and /or assistance and advice. I am responsible for my personal accident insurance & AMBULANCE cover, GVRHA will not be responsible for any cost.

DECLARATION AND SIGNATURE
BY SIGNING THIS AGREEMENT I UNDERSTAND THAT THE RECREATIONAL SERVICES ABOUT TO BE SOLD TO ME MAY CAUSE MY AND OR MY DEPENDANT
S PERSONAL INJURY OR DEATH. BY SIGNING THIS AGREEMENT I UNDERSTAND THAT I AND MY DEPENDANTS WAIVE OUR RIGHTS TO SUE THE PROVIDER FOR LOSSES RELATING TO MY AND MY DEPENDANTS PERSONAL INJURY OR DEATH THAT RESULT FROM ANY NEGLIGENCE CAUSED BY THE PROVIDER.

I/WE HEREBY AGREE TO
ABIDE BY THE RULES OF THE GOULBURN VALLEY REINING HORSE ASSOCIATION:
SIGNATURE *

Clear

Download Print and Sign the Insurance Waiver Attached Below and return to GVRHA
Should be Empty:

GOULBURN VALLEY REINING HORSE ASSOCIATION MEMBERSHIP APPLICATION