Membership Application Form Personal DetailsFirst Name *Last Name *Gender *MaleFemaleDate of Birth *dd/mm/yyPhone *Mobile Fax 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 -1/102/103/104/105/106/107/108/109/1010/10Do you compete in or have you ever competed in... Rope & TieSteer WrestlingBreakaway RopingCuttingCamping DraftingWestern Pleasure Membership Details *Family Discount: 10% only applies if all members are paying at the same time. Veteran's Discount: Card holders only.21/22 Member – Senior $17621/22 Member – Junior $88Tiny Tot & Junior Looper (complimentary)10% Family DiscountVeteran's Discount $88.00Life Member $150Associate Member (Non-Competing member) $66 Please complete and submit family members forms. Membership is not valid until this completed form and payment has been made to the ATRA.Terms & 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. Payment MethodPlease Choose a payment method *Direct Deposit (BSB: 032 621 A/C: 325 664)Mail cheque to Head OfficeCredit Card payment VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank:
