Hurlingham Polo Association

Manor Farm

Little Coxwell

Faringdon

Oxon SN7 7LW

Tel: 01367 242828 Fax: 01367 242829

Email: enquiries@hpa-polo.co.uk Website: www.hpa-polo.co.uk

 

 

HURLINGHAM POLO ASSOCIATION (HPA) REGISTRATION FORM

 

Last Name

 

Main Club:

 

First Name

 

Other Clubs

 

DOB

 

 

 

Country of Residence:

 

Pony Club

 

Gender: (M/F)

 

School/University

 

Contact Address

Home/Work*

Other Address

Home/Work/Term Time*

 

 

 

 

 

 

Phone No

 

Phone No

 

Fax No

 

Fax:

 

Mobile

 

Email:

 

* Please delete                                     

 

Associate Membership Classification

UK/Eire Resident

Tick

Overseas Resident

Tick

Full

£100

 

£180

 

Temporary (same for Arena)

£50

 

£80

 

Junior (includes Arena season)

£35

 

£65

 

Chukka

£75

 

£105

 

SUPA only (includes Arena season)

£35

 

n/a

 

Arena Full

£100

 

£180

 

Arena if already a full member

£50

 

£50

 

Arena only Under 14

£10

 

£45

 

 

 

TERMS AND CONDITIONS

·          To abide by the Rules, Regulations, Orders and Directives from time to time in force of the …………………………..Polo Club and the HPA in accordance with Regulation 3 in the Year Book of the HPA.

·          To understand the risks of the game of polo and acknowledge that polo is a dangerous sport and that participation of the sport is at my own risk.

·          To indemnify and hold harmless the HPA, host club and any other sponsor, charity or other beneficiary which may benefit from an event, and all directors, governors, officers, trustees, agents, employees, or servants of any of the above named entities (collectively the “Indemnified Parties”), from any claim, for any personal injury or property damage sustained by any person or entity, including, without limitation, all third parties, all other members, entrants and any person performing services for any of the Indemnified Parties, caused in any club or HPA sanctioned activity, tournament or ground by myself, my agents, employees and/or their mounts.

·          To be responsible for any injury or damage caused by myself, my agents, employees and/or their mounts, and to bear the costs of any legal proceedings which I might initiate.

By signing this registration form and accepting the privileges of the HPA, I acknowledge that I have read, understand, accept and agree to the terms and condition as set forth.

 

Signature :______________________________________________________________   Date:_________________

If under 16:  As the parent/guardian, I understand and accept the Terms and Conditions on behalf of the above, and consent to the above being subject to drug testing in accordance with the  Regulations as set out in the Year Book of the HPA.

Guardian Signature:________________________ Name____________________________              Date:_________________

 

A portion of the fee includes your year book, which you should obtain from your club, and insurance.            

 

CLUBS TO RETAIN THIS SHEET