Preferred Name(for Name Badge):
DETAILS OF PRIMARY RIDING MEMBER
Spouse/Partner's Preferred Name (for Name Badge):
Street Address or PO Box:
Mobile Number (if no mobile, please use home number):
In case of accident, please supply a contact phone number of spouse/partner/next of kin:
IF APPLYING FOR FAMILY MEMBERSHIP
(additional fee of $5.00) please fill in the additional details below.
DETAILS OF ADDITIONAL FAMILY RIDING MEMBER:
Preferred Name (for Name Badge):
Fees cover membership from the 1st May of the current year until the 30th April of the following year
ADDITIONAL FAMILY RIDING MEMBER
Late Fee (applies from 1st August)
I agree to the conditions above
I disagree with the conditions above
Transaction Identifier - Description sent to Recipient's Bank (please include your initial and surname):
Amount Deposited or Transferred: $
You may enter any additional information in the comments box below.
On completion of the form, submit it to the Club via the 'Submit Form' button above.
You will then be transferred to another page, and asked to list the details of your CRS machines.
Please take time to fill in details of bikes you own that are registered under the Concessional Registration Scheme (CRS) i.e. Veteran, Vintage or Historical registration in the ACT (V-plate) or Historic Vehicle registration in NSW (H or G-plate). Those with motor vehicles (cars, trucks, vans, etc) registered under CRS should also list those vehicles.
Hint: Use the TAB key on your keyboard to go to the next field.