Thames Mountain Bike Club Membership Form

Thames Mountain Bike Club

Membership form
Fill in your details below to register as a member of the Thames Mountain Bike Club. The membership period runs from January 1st to December 31st.
Full Name *

First Name Last Name
Address: *

Street Address

Street Address Line 2

Town/City

Post Code
Date Of Birth *

Month Day Year
Date
E-mail *
example@example.com
Mobile Phone Number
Home Phone Number
Family Membership option

Family (Select this option if signing up 2 or more members, Must reside at same address)
2nd Family Member - Full Name

First Name Last Name
2nd Family Member - Date Of Birth

Month Day Year
Date
2nd Family Member - E-mail
example@example.com
2nd Family Member - Mobile Phone Number
Add a 3rd Family Member

Yes
3rd Family Member - Full Name

First Name Last Name
3rd Family Member - Date Of Birth

Month Day Year
Date
3rd Family Member - E-mail
example@example.com
3rd Family Member - Mobile Phone Number
Add a 4th Family Member

Yes
4th Family Member - Full Name

First Name Last Name
4th Family Member - Date Of Birth

Month Day Year
Date
4th Family Member - E-mail
example@example.com
4th Family Member - Mobile Phone Number
Add a 5th Family Member

Yes
5th Family Member - Full Name

First Name Last Name
5th Family Member - Date Of Birth

Month Day Year
Date
5th Family Member - E-mail
example@example.com
5th Family Member - Mobile Phone Number
Add a 6th Family Member

Yes
6th Family Member - Full Name

First Name Last Name
6th Family Member - Date Of Birth

Month Day Year
Date
6th Family Member - E-mail
example@example.com
6th Family Member - Mobile Phone Number
Add any extra notes or comments you'd like to include here :

Membership payment selection *

Adult Membership 1 Adult Membership

$ 25.00 NZD Quantity

Junior Membership 1 Junior 16 years or younger

$ 15.00 NZD Quantity

Family Membership Two adults and unlimited number of children within the same household.

$ 50.00 NZD

Enter coupon

Total

$ 0.00 NZD

Payment Options:

Cash: Payment can be made in cash or by eftpos at Jolly Bikes, 96 Richmond Street, Thames 3500

Internet Bank Transfer. Please put your surname details in the particulars for the online transfer. Banking account No: 06 0457 0139627 00
Should be Empty: