Membership Application
April 2026 - March 2027
Applicants Details
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Mobile Number
*
-
Area Code
Phone Number
Rider Details
Rider 1 Details
*
First Name
Surname
Rider 1 Class
*
Mini
Junior
Senior
Vet
Rider 2 Details
First Name
Surname
Rider 2 Class
Mini
Junior
Senior
Vet
Rider 3 Details
First Name
Surname
Rider 3 Class
Mini
Junior
Senior
Vet
Rider 4 Details
First Name
Surname
Rider 4 Class
Mini
Junior
Senior
Vet
2026 Club Fees
*
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Annual Individual Membership
$40.00 NZD
$
40.00
NZD
Annual Family Membership
Family membership is up to 4 riders. Please complete rider detail fields below.
$60.00 NZD
$
60.00
NZD
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Emergency Contact Information
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
-
Area Code
Phone Number
Agreement
Please read and acknowledge
*
I/We agree to abide by the rules and regulations of MNZ and those of the Kapi Mana Motorcycle Club.
Date
*
-
Day
-
Month
Year
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