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AGILITY DOG ASSOCIATION
OF AUSTRALIA LTD
ABN 83 070 415
404
ONLINE NEW MEMBERSHIP FORM
Fill out the
following details, submit your form (click submit button at end of
page), and then print two copies of the confirmation page - one
for your records and one to send to ADAA with your payment. After
this has been completed, please
fill out your dog(s)
registration if applicable.
TO FINALISE THIS FORM click on the
'Submit' button at the end of this page. Please check the information you have
provided above thoroughly before submitting your membership - thanks. When you
finalise this form you will be taken to a page to confirm the submission was
successful. You will be able to print a copy for your records and to forward to
ADAA with your payment.
Please allow 14 days after receipt of payment for processing of Membership
Applications. Any enquiries should be made a minimum of 21 days after dispatch
of Applications. The applicant(s) may not enter an ADAA competition without
having received their ADAA membership confirmation and registration details.
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NEW MEMBER(S) DETAILS (Dual
and Family Memberships accepted only if all members are located at the same
house [address])
*The Junior Program is
restricted to Junior members (have their own membership category) or Full
members between the age of 10 and 16 (inclusive) that are included on a
Family membership (refer to Rules and Regulations, Section 5).
NOTE: A Valid Email
address is required for Electronic Memberships. If no email
address filled out your electronic membership can not be processed.
The applicant(s) may not enter an ADAA competition without having received
their ADAA membership confirmation and registration details.
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►TITLE:
SURNAME: FIRST NAME: GENDER:
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PHONE:
Day
Night
Mobile
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EMAIL ADDRESS 1:
EMAIL ADDRESS 2:
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DOB if *Junior:
(10-16 years inclusive) |
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>
No more members, go
to next section of form |
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►TITLE:
SURNAME:
FIRST NAME: GENDER:
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PHONE:
Day
Night
Mobile
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EMAIL ADDRESS 1:
EMAIL ADDRESS 2:
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DOB if *Junior:
(10-16 years inclusive) |
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>
No more members, go
to next section of form |
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►TITLE:
SURNAME:
FIRST NAME: GENDER:
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PHONE:
Day
Night
Mobile
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EMAIL ADDRESS 1:
EMAIL ADDRESS 2:
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DOB if *Junior:
(10-16 years inclusive) |
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>
No more members, go
to next section of form |
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►TITLE:
SURNAME:
FIRST NAME: GENDER:
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PHONE:
Day
Night
Mobile
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EMAIL ADDRESS 1:
EMAIL ADDRESS 2:
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DOB if *Junior:
(10-16 years inclusive) |
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>
No more members, go
to next section of form |
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►TITLE:
SURNAME:
FIRST NAME: GENDER:
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PHONE:
Day
Night
Mobile
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EMAIL ADDRESS 1:
EMAIL ADDRESS 2:
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DOB if *Junior:
(10-16 years inclusive) |
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>
No more members, go
to next section of form |
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►TITLE:
SURNAME:
FIRST NAME: GENDER:
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PHONE:
Day
Night
Mobile
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EMAIL ADDRESS 1:
EMAIL ADDRESS 2:
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DOB if *Junior:
(10-16 years inclusive) |
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>
No more members, go
to next section of form |
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Your Address: |
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ADDRESS (Line 1):
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ADDRESS (Line 2):
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SUBURB / TOWN:
STATE:
POSTCODE:
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Upon initial membership ADAA (any
category) registration of dog(s) is at no cost to the member.
How many dog(s) will you be registering with your membership? Number of
Dogs:
After you submit this page you will be able to fill out your dog
registration details. |
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I / We hereby apply for membership / renewal to the
Agility Dog Association of Australia Ltd ABN 83 070 415 404 (ADAA). In
the event of membership admission, I / We agree to be bound by the Memorandum and
Articles of Association and Regulations of ADAA for the time being in
force. I / We have not been convicted of an offence under any legislation relating to
cruelty to animals.
Please confirm that you agree to the above conditions:
Note: Form will
not process if 'No' is selected.
Has anyone on this membership
been a member of ADAA previously?
If Yes, your previous Membership Number (if known)
If Yes, and your name has
changed, your previous name(s):
Prospective ADAA member(s) are obliged to provide details of any and all
incidents that you, or a dog owned or handled by you, have been involved in
that may affect your membership with ADAA . This may include, but not be
limited to, incidents that have been reported to another organisation, local
council etc. Please be aware that ADAA will not be in a position to impose
disciplinary action against you for any past actions taken, or not taken, by
you. However, we may, if we deem it necessary for the protection of our
members, their families and their pets and the members of the public, decide
not to accept a membership application, not to register a dog with ADAA or
request that an aggressive dog is crated when not competing and muzzled at
any time when not crated, except when actually competing in the ring.
Incident Details if applicable:
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Select your Membership Type
(refer to table below for a quick overview of available
memberships)
►
Membership Delivery
Electronic
($15.00 for 3 years)
Written ($15.00
for 3 years + $30 per annum for mailouts)
►
Membership Type
► I /
We would like to purchase a copy of the Agility Regulations ($10.00 - price
includes postage)
Yes
No
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| ADAA Membership
Types |
Amount |
Electronic Communication
Membership (Single, Dual, Family, Junior) - Three yearly renewals ($15
for three years)
The discounted Electronic membership means that notices and updates etc will
be sent via email, the website etc. Membership Numbers and Dog Registration
Information will be advised electronically (email) only.
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$15.00 |
Written Communication Membership
(Single, Dual, Family, Junior)
- Three yearly renewals ($15 for three years + $30 per annum for mailouts)
Notices, updates, Membership Numbers and Dog Registration Information will
be sent and advised by normal post only at a cost of $30.00 per year.
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$45.00 |
| **Copy of the AGILITY REGULATIONS
(including postage) |
$10.00 |
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Some of the information you provide may be released to clubs holding an ADAA competition. This information is: Your Name, ADAA Membership No
and Dog
Name, Height, and Dog Registration No. The
same information is required on a Competition Entry Form. This information
is used for competition management and for printing running orders, scribe
and score sheets, and ADAA Clear Round / Qualifying Cards only. If you do
not wish to have the above details passed on for ADAA competition purposes,
please tick the box:
Do not
release the above details for competition purposes.
If this is ticked all details are kept private - including
any achievements (eg: your dog's titles will not be displayed in the 'Hall
of Fame', handler awards will not be displayed etc. If you tick this
please ensure that the details you provide on your competition form are
accurate to save the competition secretaries chasing up information).
TO SUBMIT THIS FORM click on the
'Submit' button at the end of this page.
Please check the information you
have provided above thoroughly before submitting your membership -
thanks. When you submit this
form you will be taken to a page to confirm the submission was successful. You will be able to print a copy for your records and to forward to ADAA with your payment.
Upon initial membership ADAA (any
category) registration of dog(s) is at no cost to the member.
After completing your application,
fill out your dog(s)
registration (if applicable).
Registration of
additional dog(s) at a later date will be charged at a fee of $5.00 per
dog. |
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You will need to send a printed
copy of the form confirmation page, with your original signature and payment
enclosed to ADAA. Prices and payment details are on the Membership form. You may
not enter an ADAA competition without having received your ADAA membership
confirmation and registration details from ADAA.
Cheques / Money Orders should be made payable
to:
AGILITY DOG ASSOCIATION OF AUSTRALIA LTD
Cheques / Money Orders and a
printed copy of this form (print version appears after you select 'Submit') should
be sent to:
THE
SECRETARY
AGILITY
DOG ASSOCIATION OF AUSTRALIA
LTD
PO Box 2212
Gailes Qld 4300
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Before submitting double check that the details you have provided are
correct - thanks. |