The Painted Pony Club House

Application

You can apply to be a member of The Painted Pony Club by filling out and submitting this form. Only registered users are allowed into The Painted Pony Club. Choose a username for yourself (such as your last name) and make sure this username contains no spaces. Also create a private password. Together these will be your "key" into The Painted Pony Club from now on. This information will be kept in a registration database that is accessible only to the webmaster, not to ordinary users.

After you are successfully registered your web browser will ask you to type in your username and password the first time you try to access The Painted Pony Club. The browser will remember this information for as long as it continues to run, so you can access any document in The Painted Pony Club without being asked for it again. 

Registration normally takes 24hours and confirmation will be by Email

Form Submission

Fields marked with * are required.

Personal Details
Title:   *  
First Name:   *  
Surname:   *  
Company Name:    
Delivery Address:   *  
Suburb / Locality:   *  
State:   *  
Post / Zip Code:   *  
Country:   *  
Phone Number:   *  
Fax Number:    
Favorite Product:   *  
Skin Concerns:   *  

The Painted Pony Club is exclusive to clients of The Painted Pony. If you are not currently a client your application may not be accepted. If you have a friend who is a client and they wish to refer your application please enter there name

Referred By:   *  
 
Please choose a username and password for your Painted Pony Club Membership.
The password should be a secure one that no-one can guess.
The password must be at least 6 characters long.
 
Make up a username:   *   -- you can use mixed case
Make up a password:   *   -- keep this private!
Enter password again:   *   -- for verification
Enter e-mail address:   *   -- if you have one