Patetonga Motorcycle Club Membership Registration Form

Club Membership Registration

Complete the form below to sign up for Patetonga Motorcycle Club Membership for the 2024/25 Season(1 September 2024 to 30 September 2025). Please deposit fees using the following account details - Westpac 03-1573 0041429-000
Type of Membership*

NewRenewal
Membership*

Single $50Family $80 (everybody must reside at same address)
I will direct credit Westpac 03-1573 0041429-000 *

Yes I agree, and will use MEMBERSHIP and Surname as reference
Primary Riders Details
Name*

First NameLast Name
E-mail*
Mobile Number*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Rider*

MiniJuniorSenior
MNZ Licence No
If you have one
Transponder Number
If you have your own
Other Rider details
2nd Riders name
2nd Rider

MiniJuniorSenior
MNZ Licence No
If you have one
Transponder Number
If you have your own
3rd Riders name
3rd Rider

MiniJuniorSenior
MNZ Licence No
If you have one
Transponder Number
If you have your own
4th Riders name
4th Rider

MiniJuniorSenior
MNZ Licence No
If you have one
Transponder Number
If you have your own
5th Riders name
5th Rider

MiniJuniorSenior
MNZ Licence No
If you have one
Transponder Number
If you have your own
6th Riders name
6th Rider

MiniJuniorSenior
MNZ Licence No
If you have one
Transponder Number
If you have your own
Membership Rules
MEMBERSHIP RULES

Membership Cost: Single - $50.00 / Family - $80.00

Any queries to Maurice Hayman 027 473 5762

Declaration: I hereby declare that as a member of the Patetonga Motorcycle Club Inc, I shall be bound by all the stated and said club rules, race day rules, practice day rules, by laws and decisions by the respective executives of Patetonga Motorcycle Club Inc and shall comply by the same.

In accordance with the conditions set out in the Privacy Act 2020, all information contained in the above registration form shall be held as strictly private and confidential.
Check to agree with terms of club membership

I have read, understood, and accepted the rules for membership.Signature Of Applicant or Parent if Under 16I have read, understood and accept the rules and regulations of MNZ
Signature*
Once you submit your application, we will email you to comfirm your membership application.

Thank you!
Should be Empty:

Club Membership Registration

Primary Riders Details

Other Rider details

Membership Rules