Ballarat Pony Club Annual Facility User Application
Name
*
First Name
Last Name
E-mail
*
example@example.com
Mobile
*
I am a member or parent/guardian of a member of Ballarat Pony Club OR a member of FOBEA
*
Yes
No
Facility User commencement date (please allow 48 hours for processing)
*
/
Day
/
Month
Year
Date Picker Icon
Payment
Membership is not confirmed without payment. Complete payment details and submit. Bank details: BSB - 633000 Account - 144990942 Account name: Ballarat Pony Club
Select membership type
BPC or FOBEA member - $100/year
EA, HRACV or other - $200/year MUST provide copy of membership on application booking
Enter amount paid
*
Enter payment reference
*
Upload remittance advice and insurance membership
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