Membership Application
April 2025 - March 2026
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
*
2025 Club Fees
*
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Annual Individual Membership
$
40.00
NZD
Annual Family Membership
Family membership is up to 4 riders. Please complete rider detail fields below.
$
60.00
NZD
Methods of payment: Please select one.
*
Cash - Complete the online form and pay at the next event. Please advise the sign on desk you are paying for your membership. You will be given your membership card.
Internet Banking - Complete the online form and pay directly into the Kapi Mana Motorcycle Club Inc bank account: Westpac 03 0547 0884946 01 Please use your surname and 'Membership' as reference i.e. Smith Membership. At the next event please advise the sign on desk you have paid online. You will be given your membership card
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
Emergency Contact Information
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid 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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