Membership Form Membership Step 1 of 3 - About You 33% Personal informationName* First Last Email* TelephoneMobile PhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Membership area*North WesternSouth WesternNorth EasternGippslandINTERSTATEReciprocal members - Interstate Membership number*Reciprocal members - Interstate Membership numberAre you are a Junior ? Tick if you are a Junior Authorisation by Parent / GuardianParent / Guardian Authorisation to join and participate* I am the parent/guardian of the above applicant and give permission for him/her to apply for membership of the VYUFDA. I acknowledge that there are some inherent risks associated with the activity and accept the risks. I indemnify the VYUFDA against legal action in the case of the above applicant suffering any injury due to their size or age. I have read and understand that the condition of membership with the Victorian Yard Utility Farm Dog Association Incorporated is to abide by the constitution and competition rules. I agree that both I and the aforementioned junior applicant will abide by them. I understand that contact details will not be published unless the member is elected as an office holder. I understand that photos of my child participating on a trial course, training day or official activity may be published by the Association. Parent / Guardian Name* First Last Parent / Guardian NameParent / Guardian phone number* New member Form* This is a new member form. Please provide 2 referee names New Member ReferencesReferee One name (current VYUFDA member)* First Last Referee Two name (current VYUFDA member)* First Last Membership type*Full Competing Member until December 31 2020 | $70.00Junior competing member under 18yrs until December 31 2020 | $10.00Supporting Member until December 31 2020 | $20.00Reciprocal MemberAmount Due $ 0.00 Payment Method*I'm paying by Bank Transfer ;Bank deposit to: BSB 633-000 ACC 101277812 (please use full name as reference)I'm paying by cheque ;Cheques Payable to: VYUFDA - Post To: VYUFDA c/o Treasurer, Bill Spiteri, PO Box 563, Aireys Inlet 3231Reciprocal ;$0AgreementsConsent* I understand that none of my contact details will be published unless I am elected as an office holder.Consent* I understand that photos of me participating on a trial course, training day or official activity may be published by the Association.Who are youTell us a bit about you.About You / Reciprocal Membership details*Tell us a bit about you. If you have selected "Reciprocal Membership", provide us with a valid interstate membership number.What work experience do you have that VYUFDA might find useful.CommentsThis field is for validation purposes and should be left unchanged.
