Return to Club Secretary
PO Box 1445
Capalaba 4157
[email protected]
Sled Dog Racing Queensland Inc.
Membership Application Form
CHOOSE APPROPRIATE OPTION:
Membership renewal
New member
I/We the undersigned of (Name and residential address)
__________________________________________________________________________________
__________________________________________________________________________________
Email: ________________________________________ Mobile: ____________________________
MEMBERSHIP OPTIONS:
New Single Membership
(includes club safety kit)
$80
New Family (2 Parents and Children up to 18) / Couples Membership
$125
(includes club safety kit, additional safety kit option for $45 at time of joining)
Single annual membership renewal fee
$45
Family annual membership renewal fee
$80
Members’ Safety Kit
$60
Club Shirt (S,M,L,XL)
$TBA
Size: ______________
PERSONAL INFORMATION:
Emergency Contact: ______________________________ Relationship to member:______________
Phone:___________________________________ Mobile: __________________________________
Please provide details of any medical conditions: (and details of emergency treatments e.g. location
of Epipen/medications)______________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
________________________________________________________________________________
As a Member/s of Sled Dog Racing Queensland Inc. I/we Agree to:
• Supply copies of all dogs’ current vaccination certificates, and provide copies of future certificates when
boosters occur.
• Abide by the Incorporation Rules, Club Rules and Code of Conduct of Sled Dog Racing Queensland Inc.
• Act as reputable members of SDRQ Inc. by upholding the code of conduct and objectives of the club
• Allow Sled Dog Racing Queensland Inc. to use photo and footage of the members named on this form for
promotional material (newsletters, printed or web based)
SDRQ Inc Updated 9 April 2015
Membership Includes:
• A Starter Information Pack
• A copy of the Incorporation & Club rules and Code of Conduct Policy
• Branded Safety Kit
• Insurance coverage for Sled dog Racing Queensland Inc. events
• Discounted race entry fees
PAYMENT INFORMATION:
Payment can be made by Cash, Cheque or EFT transfer.
Account name: Sled Dog Racing Queensland Inc.
BSB: 302 162
Account: 075604 1
I/We enclose $ ______________________ being for the payment of Membership Fees/ Club shirt.
Signature/s (over 16yrs): ____________________________________________________________
Parent/Guardian Signature (Under 16yrs): ______________________________________________
Name and address of Parent/Guardian: ________________________________________________
Membership includes ASSA membership and insurance. However in the event of a claim please note
there is a $2500 excess fee that will be at the claimant’s expense.
How did you hear about us?
_______________________________________________________________________________
Have you raced dogs before? Where? Skill Level?
_______________________________________________________________________________
Is there anything you may be able to assist SDRQ Inc. with?
Details of your dogs:
Dog Name
Age /Sex
Breed
Vaccination Cert. Sighted
OFFICE USE ONLY
Amount Paid: __________________
Date Paid: ________________________
Paid by (Circle one): CASH
CHEQUE
EFT TRANSFER
Receipt Number: ________________ Member Number: _____________ Musher starter kit received: YES / NO
Nominated By: _________________________________ Seconded By: _________________________________
SDRQ Inc Updated 9 April 2015