AUSTRALASIAN TEAM ROPING ASSOCIATION
ABN: 94 620 859 177
Po Box 1244
Warwick, Qld 4370
email: admin@teamroper.com.au
2011-2012 MEMBERSHIP APPLICATION FORM
1st July 2011 - 30th June 2012
Personal Details
First Name
Last Name
Gender
Date of Birth
Postal Address
Residential Address
City
State
Post Code
Home Phone
Mobile
Fax
Email
Header
Heeler
# of Years Roping
Saddles Won
Buckles Won
Average number of catches out of 10
Rope and Tie
Steer Wrestling
Breakaway Roping
Cutting
Campdrafting
Western Pleasure
Other
Adult
$100
Junior
$50
Junior Looper (complimentary)
10% family discount
Roping Details
Classifications
Do you compete in or have
you ever competed in..
Membership Details
please complete and submit family members forms
Membership is not valid until this completed form and payment has been made to the ATRA.
I have read, accept and understand the terms and conditions of membership and agree that by submitting this form to abide by them.
Terms and Conditions
-
Female
Male
-
QLD
TAS
NSW
VIC
NT
SA
WA
-
1
2
3
4
5
6
7
8
9
-
1
2
3
4
5
6
7
8
9
-
0-3yrs
4-9yrs
10+yrs
Payment Details
please either PRINT and scan this form to admin@teamroper.com.au or send this page by email