Event Membership Application Form Event detailsEvent Name * Personal DetailsFirst Name *Last Name *Date of Birth *dd/mm/yyHome phone *Mobile Email *Postal Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryAboriginal or Torres Strait Islander YesNoFellow member that recommended the ATRA to you Membership Number (If previous member) Roping DetailsHeader -122.533.544.555.566.577.588.59Heeler -122.533.544.555.566.577.588.59Temporary Number Assigned by fellow member - Header -123456789Temporary Number Assigned by fellow member - Heeler -123456789Fellow Members name that assigned temporary Classification Years of Roping Please enter a number.0yrs0-3yrs4-9yrs10+yrsSaddles won Please enter a number.Buckles won Average number of catches out of 10 -1/102/103/104/105/106/107/108/109/1010/10 Membership Details *(Juniors cannot turn 18 between 1/7/21 – 30/6/22) Event memberships are required to be paid at each event unless the competitor is already a full ATRA member. 1 event may run over several days & would only require 1 Event Membership or promoters may choose to run 2 separate events on a weekend & therefore payment for 2 days can be made with only 1 form. To be eligible to earn Regional & National Points & be awarded National Finals spots a competitor must be a FULL financial member at the time of the event. Membership year is 1st July – 30th JuneJACKPOT EVENT MEMBERSHIP: Senior $44JACKPOT EVENT MEMBERSHIP: Junior $22JACKPOT EVENT MEMBERSHIP: Senior 2 x days $88JACKPOT EVENT MEMBERSHIP: Junior 2 x days $44CLINIC / SCHOOL MEMBERSHIP: Senior $20CLINIC / SCHOOL MEMBERSHIP: Junior $20CLINIC / SCHOOL MEMBERSHIP: Family $50TRAINING / DEVELOPMENT DAY MEMBERSHIP: Senior $20TRAINING / DEVELOPMENT DAY MEMBERSHIP: Junior $10TRAINING / DEVELOPMENT DAY MEMBERSHIP: Family $50Terms & Conditions *I hereby state the above and following answers to be true. I will not hold the ATRA, any of its producers or sponsors responsible for any accidents to myself, my family, my equipment or any of my livestock when driving to, from or while at any ATRA events. I agree to abide by the rules of the Australasian Team Roping Association and each event producer as set out. I also understand that and agree that my image subsequently be used for publicity or promotional purposes or TV rights my name and/or pictures of me participating in this association without any obligation or liability from me. In making this Statement and Release, I further acknowledge that I am aware that equine events are dangerous sports and that serious injury can frequently occur. I understand that the ATRA endorses the guidelines of care for livestock as set out by the National Consultative Committee on Animal Welfare (2006) for the Care and Treatment of Rodeo Livestock. I further acknowledge that I have read this statement and understand its contents.I have read, accept and understand the terms and conditions of membership and agree that by submitting this form to abide by them.Emergency Contact Name & Number Payment MethodPlease Choose a payment method *Direct Deposit (BSB: 032 621 A/C: 325 664)Mail cheque to Head OfficeCredit Card payment Minor consent The following must be completed if applicant is a minor: I declare that I am one of the parents/legal guardians of the above named minor; that I have carefully read the foregoing Statement and Release, that I know the representations made are true; and that I agree to be bound by the terms of the Statement and Release both personally and as a representative of the interest of the minor.Parent/Guardian Full Name VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank:
