Membership

Adult Membership
Junior Membership

"*" indicates required fields

Name*

First Last

Email*

Mobile*

Postal Address*

Street Address Address Line 2 City State Post Code

Date of Birth

Consent*

I confirm I am 18 years of age or over.*

Consent*

I hereby apply to become a member of the Association and agree to be bound by the rules of the Association as per the Mildura Harness Racing Club Rule Book supplied on application.*

Consent

Yes I would like to be subscribed to the newsletter

1x Adult Membership

Price:

Credit Card

Card Details

Cardholder Name

This field is for validation purposes and should be left unchanged.

"*" indicates required fields

How Many Juniors?*

Junior Details #1*

Full Name

Date of Birth

Junior Details #2*

Full Name

Date of Birth

Junior Details #3*

Full Name

Date of Birth

Junior Details #4*

Full Name

Date of Birth

Junior Details #5*

Full Name

Date of Birth

Junior Details #6*

Full Name

Date of Birth

Junior Details #7*

Full Name

Date of Birth

Junior Details #8*

Full Name

Date of Birth

Junior Details #9*

Full Name

Date of Birth

Junior Details #10*

Full Name

Date of Birth

Parent/Guardian Email Address*

Parent/Guardian Mobile*

Postal Address*

Street Address Address Line 2 City State Post Code

Consent*

I hereby apply to become a member of the Association for the 2017-2018 financial year, and agree to be bound by the rules of the Association. I understand that as a Junior Member I have no voting powers.*

Consent

Yes I would like to be subscribed to the newsletter

Total Membership Cost*

Price: $ 1.00

Credit Card

Card Details

Cardholder Name

Comments

This field is for validation purposes and should be left unchanged.

Follow us on social media

Racing

Hospitality

Get Involved

Shop

About

Location