Membership Form 2022

Whangarei Motorcycle Club 2022 Membership

Complete the form below to apply for membership to the Whangarei Motorcycle Club for the 2022 season. Membership is from the 1st July 2022 - 30th June 2023
Contact information *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
E-mail *
Contact Phone Number: *

Area Code Phone Number
Type of Membership *
Membership mailed or picked up at next event *
Number of Riders
Rider 1 Name *

First Name Last Name
Rider 1 Class
Rider 1 Bike Size cc
Rider 1 Racing Number
Rider 1 Age
Rider 2 Name *

First Name Last Name
Rider 2 Class
Rider 2 Bike Size cc
Rider 2 Racing Number
Rider 2 Age
Rider 3 Name *

First Name Last Name
Rider 3 Class
Rider 3 Bike Size cc
Rider 3 Racing Number
Rider 3 Age
Rider 4 Name *

First Name Last Name
Rider 4 Class
Rider 4 Bike Size cc
Rider 4 Racing Number
Rider 4 Age

Membership Fees *

Membership Fees

Class	Quantity	Price
Senior		$ 55.00 NZD
Junior		$ 35.00 NZD
Mini (Trail (eg TTR, PW CRF 50, 70, 80 etc) & 65)		$ 30.00 NZD
Non Competiitve (non-riding)		$ 10.00 NZD
Family (must be living under the same roof)		$ 90.00 NZD

Total $ 0.00 NZD

Confirm Payment *

I will deposit the above membership fees into the following account. Account Name: Whangarei Motorcycle Club, Account Number:02 0492 0045124 00. Reference your family name.
Signature *

Clear
WMC is an MNZ Alliliated club. An MNZ licence or day licence is required to enter Club MX events, this is not included in Club Membership.

For a MNZ Membership form please down load from : www.mnz.co.nz

Whangarei Motorcycle Club

PO Box 905

Whangarei 0140
Should be Empty:

Whangarei Motorcycle Club 2022 Membership