NEGRC Life Membership Form 2018

Hereby apply for Membership with the Northern Exposure Gig Racing Club Inc, for the period

1st January 2018 to 31st December 2018.

The signatory is entitled to:

One Musher starter kit (New members only, one per family / individual)
Comprehensive Insurance whilst at NEGRC Inc events
Participate in NEGRC Inc events & competitive races, subject to club rules & normal race entry requirements

Annual NEGRC Inc & ASSA Affiliate membership
Receive NEGRC Inc publications including Trail Magazine & On Track Newsletter & access to NEGRC members facebook group.

Personal Information

First Name *

Last Name *

Address *

City *

State *

Post Code *

Phone

Mobile

Email Address *

Are your family Joining? *

Additional Family Members

*

LIFE MEMBER (Life membership from NEGRC)

Current Total:

$0.00

Enter the word in the image *
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First Name *

Last Name *

Address 1 *

City *

State *

Post Code *

Phone

Mobile

Medical Concerns &/or Allergies: *

How did you hear about NEGRC? *

How many years experience do you have running dogs? *

Dog Details

	Name	Date of Birth	Breed	Sex	Desexed/ Entire
Dog 1	Name	Date of Birth	Breed	Sex	Desexed/ Entire
Dog 2	Name	Date of Birth	Breed	Sex	Desexed/ Entire
Dog 3	Name	Date of Birth	Breed	Sex	Desexed/ Entire
Dog 4	Name	Date of Birth	Breed	Sex	Desexed/ Entire
Dog 5	Name	Date of Birth	Breed	Sex	Desexed/ Entire
Dog 6	Name	Date of Birth	Breed	Sex	Desexed/ Entire
Dog 7	Name	Date of Birth	Breed	Sex	Desexed/ Entire
Dog 8	Name	Date of Birth	Breed	Sex	Desexed/ Entire
Dog 9	Name	Date of Birth	Breed	Sex	Desexed/ Entire