HORSE ENTRY FORM/TAX INVOICE AFFILIATED WITH EQUESTRIAN AUSTRALIA, SHOW HORSE COUNCIL & FEDERAL COUNCIL OF AGRICULTURAL SOCIETIES Checklist* ENTRY FORMS MUST BE LODGED PRIOR TO CLOSING DATE - MONDAY 7th AUGUST, 2017 ALL FEES & WAIVERS MUST ACCOMPANY THIS FORM OTHERWISE ENTRY WILL NOT BE ACCEPTED COMPULSORY RIDER NO, HORSE NO OR BREED NO MUST BE PROVIDED WAIVERS FOR ADULTS & JUNIORS MUST BE COMPLETED & PROVIDED WITH ENTRY FORM PROPERTY IDENTIFICATION CODE MUST BE SUPPLIED SHOW JUMPING CLOSING DATE - MONDAY 21st AUGUST, 2017 SHOW JUMPING – EA HORSE AND RIDER REGISTRATION NUMBERS TO BE SUPPLIED Please Note: NO DOGS ALLOWED ON SHOWGROUNDS WITHOUT A GAWLER SHOW PERMIT NO CAMPING ON THE SHOW GROUNDS EXHIBITOR'S DETAILSExhibitors Name* First Surname BUSINESS NAME / GROUP (if applicable):Postal Address* Street Address Address Line 2 Town/Suburb State Postcode Telephone*PIC No.*Email* Number of years you have been exhibiting at the Gawler Show*Breed Classes - Name of Breed* Northern Agricultural Shows Association - Please refer to the Gawler Show Book for more informationI wish to enter the Junior NASA Aggregate*YesNoAge*I wish to enter the Senior NASA Aggregate*YesNo EXHIBITSENTER EXHIBITS*Horse Name and Rider/Handler Name (If Not Owner) is Compulsory (Breed, EA Rider Name & Reg No., EA Horse Name & Reg No.) Class No.Breed/Horse Reg No.Horse NameRider/Handler Name (If Not Owner)Rider No.Entry Fee FEESTotal fees from exhibits Price: $ 0.00 Administration fee (compulsory) Price: $ 2.00 Donations (Optional) MEMBERSHIP$45.00 Membership includes - 4 Admittance Tickets (Each ticket admits 1 Adult OR 3 Children between 5-16 years) Additional Tickets $12.00ea (upon purchase of a full membership)Do you want to become a Member? YES NO ALREADY A MEMBER MEMBERSHIP Price: $ 45.00 If paying membership please indicate if you would like:A full Show BookA particular ScheduleNeitherName of Schedule*Posted to you with receipt/tickets MEMBERSHIP APPLICATION I hereby apply to become a member of the Gawler Agricultural, Horticultural & floricultural Society Inc. I understand that membership must be approved by the Management Committee and that they reserve the right to accept or refuse membership without giving reason. Each Members is entitled to 4 tickets to the Gawler Show - each ticket will allow entry for 1 Adult or 3 Children (5-16 years). Members hold voting rights at the AGM - help in November each year. Members are eligible to be nominated to hold a Committee position for the duration of 2 years once accepted at the Annual General Meeting in November. Members must serve 2 years on the Committee before being eligible to gold a Senior Position. If Membership is refused all monies accompanying the application will be refunded. Membership is valid from 1st July until 30th June of each calendar year. Terms & Conditions - Membership Application* I accept the above conditions and agree to be bound by the Rules & Regulations of the Gawler AH & F Society. TICKETSDo you require additional Tickets? Additional Tickets: $12.00 eachAdditional Tickets? YES No. Additional Tickets* Price: $ 12.00 Quantity: TOTALTOTAL $ 0.00 PAYMENTPayment OptionsCredit Card (Online)Credit Card (Pay By Phone)ChequeDirect DepositPay at the OfficeCredit Card by Phone:Please call the Office on (08) 8523 1477 after your submit. - Monies must be received for the closing date. Your confirmation email will also provide this information.Cheque:Please make your cheque payable to Gawler A,H & F Society (Post to PO Box 116 Gawler 5118)Direct Deposit:Please transfer funds to BSB: 015-560 Account No: 1835 88619 using "surname - HIA" and either post or email a copy of the transfer confirmation to Show Office. Note: Direct Deposits can take up to 2 days. Pay at the Office:Please visit the Office asap to make your payment - Payment can be made by Cheque, Credit Card or Cash. Monies must be received for the closing date. Your confirmation email will also provide this information. Credit Card Details MasterCardVisa Card Number Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Expiration Date Security Code Cardholder Name CREDIT CARD FEESPAYMENT BY CREDIT CARD: Please note: a 2% services fee applies for credit card payments.2% Service Fee Price: $ 2.00 Terms & Conditions*I, the undersigned hereby declare the above Exhibits are the bona fide property of the above-named Exhibitor and entered subject to the Regulations & Conditions of the Gawler AH & F Society Inc (“the Society”). I understand that the Society accepts no liability for any accident, damage, injury or illness to animals, handlers, ground spectators or any other person or property whatsoever. I understand and permit photographs of my work to be used by the Society as required. Submission of entry is acceptance of the Society’s Code of Conduct. YES - I DECLARE & AGREE TO THE ABOVE SIGNED - EXHIBITOR OR PARENT/GUADIAN(IF UNDER 18 YRS)*NameThis field is for validation purposes and should be left unchanged.