Online Membership Form

Annual Membership Form
Please make payment to:

Direct debit:

Mercury Bay Motorcycle Club Inc.

02-0496-0133922-00

Reference: Last Name and Initials

Particulars: Membership type (Adult/Child) or CASUAL

MEMBER FEES:

2025/2026 Membership: Adult $120 / Child $90

Non Member / Casual ride: $40

MEMBERSHIP FEE IS A ONE OFF ANNUAL FEE. ALL MEMBERS CAN THEN RIDE THE TRACK ANY TIME WE ARE OPEN. OPENING HOURS ARE 1ST & 3RD SATURDAY OF MONTH AND EVERY WEDNESDAY 4PM TIL DARK. UPDATES AND ANNOUNCEMENTS WILL BE POSTED TO OUR FACEBOOK PAGE: Mercury Bay Motorcycle Club.
Riders Name

First NameLast Name
DOB:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Phone Number
Email
example@example.com
Select Member Type
Please list additional riders:
I give permission for my/our photos to be by the Club in our promotional materials, newsletters, and/or social media?
Signature:
Todays Date

MonthDayYear
Date
Should be Empty:

Annual Membership Form