5/120 /2021

Please note - fees are reviewed regularly. When forms have been retained for a period before lodgement, please check with the national office (dilutestreasurer@gmail.com) for current fees. This form must be submitted with your application.

MEMBERSHIP FEES Membership year runs from 1st August to 31st July

NEW MEMBERS

Single / Joint / Family / Stud X

Important notice regarding ALL NEW memberships:

Any person or persons who have previously been a member of any of the following: * Palominos Australia / APHA * United Palomino White Buckskin & Dun Association * Dilutes Australia Ltd are considered rejoining members, in which case the rejoining fees are applicable. If you are a rejoining member, please use an Application For Membership Renewal Form

Please indicate the fees you're paying with an

X.

New member joining between August 1st and February 28th $90 + $10 joining fee NA

New member joining between March 1st and June 30th (renewal is due August 1st) $55 + $10 joining fee NA

New member joining in July - 13 months membership (ie 1/7/19 - 31/07/20) $90 + $10 joining fee NA

Youth 17 years & under

We offer 2 types of youth memberships: * non-breeding mare / gelding owner (no voting rights) * breeding mare / stallion owner (full voting rights: can nominate an adult to exercise their voting rights) Youth members who have turned 18 will be upgraded to a full membership. They do not need to reapply as a new member.

New non-breeding mare / gelding youth owner joinng at any time $55 + $10 joining fee NA

Breeding mare / stallion youth owner

New youth member joining between August 1st and February 28th $90 + $10 joining fee NA

New youth member joining between March 1st and June 30th (renewal due August 1st) $55 + $10 joining fee NA

New youth member joining in July - 13 months membership (ie 1/7/19 - 31/07/20) $90 + $10 joining fee NA

RENEWING / REJOINING MEMBERS

Single / Joint / Family / Stud

if paid by September 30th of year in which membership is due $90

if paid between October 1st and July 31st of year in which membership is due $90 + $10 late fee

If allowed to lapse for 12 months or more $90 + $20 rejoining fee

Youth 17 years & under

Non-breeding mare / gelding youth owner

if paid by September 30th of year in which membership is due $55

if paid between October 1st and July 31st of year in which membership is due $55 + $10 late fee

If allowed to lapse for 12 months or more $55 + $20 rejoining fee

Breeding mare / stallion youth owner

if paid by September 30th of year in which membership is due $90

if paid between October 1st and July 31st of year in which membership is due $90 + $10 late fee

If allowed to lapse for 12 months or more $90 + $20 rejoining fee

NON DA STOCK OWNING MEMBERSHIPS

Not available to owners of DA registered stock

News Subscription (Magazine / Circulars etc) $55 NA

Non member showing only (covers people who regularly compete at DA run shows for insurance purposes)

$45 NA

Total membership fees: $

5/12/20210

Office use only

Mem No:

Date:

APPLICATION FOR RENEWAL MEMBERSHIP

I/We hereby apply for membership of Dilutes Australia Ltd and agree during the period of my/our

membership to abide by and be bound by the Constitution, Rules and Regulations of the Company.

Acceptance of this application is subject to Board and Branch approval. PLEASE READ THE EXPLANATORY NOTES ON THE BACK OF THE FORM BEFORE COMPLETING & SIGNING

FULL FEES APPLY Tick( Box)

Single Membership

Joint Membership (list other members below)

Family Membership (list other family members below)

FULL FEES APPLY Tick ( Box)

Youth (Mare (breeding) / Stallion Owner)

REDUCED FEES APPLY (Tick Box)

Youth Membership (Gelding / Non-Breeding Mare)

News Subscription (Magazine / News Onl )y

MR MRS MS MISS DR SURNAME:

GIVEN NAME/S: SIGNATURE:

GUARDIAN (Only complete for Youth or Junior Owner Member Application)

NAME: SIGNATURE:

NAMES OF OTHER MEMBERS: (Please list names of all other parties to Joint/Family/Stud memberships)

NAME: NAME:

NAME: NAME:

POSTAL ADDRESS: (All mail will be forwarded to this address)

STATE: POSTCODE:

� Area Code: Phone No:

Mobile N :o

� Email Address:

If you do not have an email address, do you have access to a computer? Yes / No (For electronic magazine

distribution purposes)

Your Bank Details (for reimbursement purposes only): if you agree to provide this information it will be held securely and only available to the Treasurer if required:

BSB: ACCOUNT NO:

ACCOUNT NAME: NAME OF BANK/CREDIT UNION:

NOMINATED MEMBER – THIS SECTION MUST BE COMPLETED

Must be completed and signed by the person/s appointed by the membership to hold the POWER TO INSTRUCT the Company. See Notes

for Completion on the back of this form for more details. NB: Transfers must be signed by all parties listed below.

NAME: SIGNATURE: NAME: SIGNATURE:

FEE PAYMENTS: Cheque / Money Order: Please make these payable to Dilutes Australia Ltd Direct Debit (Preferred): BANK: Bendigo Bank ACCOUNT NAME: Dilutes Australia BSB: 633 000 ACCOUNT NO: 123 341 414

REFERENCE: Please use your name

**** PLEASE POST APPLICATIONS TO:

OR EMAIL :

Dilutes Australia Treasurer

57 Road Toowoomba Old NEO MILE QLD 4305

Your No Membership DA

(preferred)

Existing

box. down pull the from select Please Branch. ueenslandQ or

Branch ACT & NSW under listed being of option the have Wales South New Northern of area the in iningoj members new and

Stud below) stud the to parties

all list ;name stud a in be (must Membership

STUD rights) voting the has who membership the within personof the name the above specify(Please MEMBERSHIPS:

STUD NAME:

ABN: 994 316 081 17

FULL .be to is membership the mean whose in person the is this - memberships

FEE EDUCEDR .member yraprim the ie membership this within RIGHTS VOTING the holds who person the is this - memberships FEE

NOTES FOR COMPLETION - PLEASE READ CAREFULLY BEFORE COMPLETING THE FORM

General Information

By applying for membership of Dilutes Australia Ltd, you agree, during the period of membership, to abide by and be bound

by the Constitution, Rules and Regulations of the Company. This includes abiding by Dilutes Australia’s Social Media Policy.

The Constitution, Regulations and Social Media Policy are all available and downloadable from our website –

www.dilutesaustralia.net.

Any person may be admitted to membership of the Company, having applied by completing this form and paying the

membership fee. Acceptance of this application is subject to Board and Branch approval. Please note that any member

wishing to resign this membership must do so in writing to the General Secretary.

Full memberships - Single /Joint / Family / Stud Memberships (Full Fee) attract all member benefits and, where there are

multiple members, will have the person named first on this form registered as the member nominated to hold voting rights.

Stud

stud. the of name the in be must Memberships

Junior Breeding Mare or Stallion Owner (Full Fee) covers a person aged 17 years & under who is the registered owner of a

mare being used for breeding or a stallion. N.B. While this membership confers full showing rights, stallions cannot be

shown by juniors due to safety regulations. The member must have an appointed guardian, who can exercise their voting

rights on their behalf.

Youth Membership (Reduced Fee) covers a person 17 years & under who owns a gelding or a mare not being used for

breeding. This membership type confers full showing rights. The member must have an appointed guardian. This

membership holds no voting rights.

News Subscription (Subscription Fee) is available to all interested parties. The subscriber will receive all magazines,

newsletters, show programmes, brochures or other newsworthy items circulated to members. It is not a membership and

has no member benefits.

Life Membership (No Fee ) payable is conferred by the Company for exceptional service. Life members pay no fees. The completion of this form is used to provide current contact details only.

• Please tick the box for the type of membership you are applying for, then fill in the name details and SIGN the form. The

person named in this section will be registered as the primary member and will hold voting rights for the membership.

• If you are applying for a Youth or Junior Owner membership, please complete and sign the guardianship section.

• Please complete the contact information details. Where an email address is provided, it will be used to electronically

deliver your copy of Kaleidoscope magazines, member circulars, some event or meeting notices, receipts for your fee

payments etc.

Your Bank Details

Supplying your personal banking information is purely voluntary. If you trust us with this information we will only use it if it

becomes necessary to refund any monies we owe you – overpayments or incorrect payments of fees, free memberships

should you win one, prize money for our National Supremes etc. We understand the sensitivity of this information. It will be

held securely off line and only able to be accessed by the Treasurer if it becomes necessary. If you prefer not to give us these

details, we will send you any reimbursements by cheque instead.

**Nominating an instructing person**

All memberships with a voting right must appoint one of the listed members, who must be over the age of 17 years, to be the

person from whom the Company will take all instructions relating to that membership, and the ownership of horses

registered to the membership. Please Note: DA Ltd registration certificates DO NOT provide any proof of legal or beneficial

ownership of any horse, but contain information provided to the Company for the purposes of the Company’s records.

Transfers etc must be signed by all parties listed.

Insurance Waiver

As part of your membership the Company provides equine liability insurance. Insurance waivers will be made available at ALL

Branch and Company fixtures. Everyone who participates in an event – members, strappers, other helpers - MUST complete

and sign the appropriate waiver. Failure to do so may affect your coverage. Annual waivers are no longer required.

5/12/20210