2025 NRMX CLUB MEMBERSHIP APPLICATION

2025 NRMX CLUB MEMBERSHIP APPLICATION
Thank you for choosing to affiliate with the NRMX.

This membership enables the competitor to apply for an MSA Motorsport License at www.msaonline.co.za or contact Cleo at cleo@motorsport.co.za

Your membership also helps support the MSA Northern Regions Regional Motocross Championship.

Please complete a registration form for each applicant.
MEMBER DETAILS

Please complete the details of the member below
Name & Surname*

NameSurname
ID Number*
Email Address*
Phone Number*
PARENT/GUARDIAN DETAILS

In the event that the member is under the age of 18, please complete the parent/guardian details below
Name & Surname

NameSurname
ID Number
Email Address
Phone Number
MEMBERSHIP DETAILS

Please note that pro-rata annual membership fees will be taken into account after 1 June 2025
Please choose an option below:*

1st Family Membership - Annual Fee: R5002nd Family Membership - Annual Fee: R400One Event Membership - R200 per event (to be submitted and paid before close of entries)
Please choose the event below*
NRMX Banking Details:
Account Name: NRMX Club
Bank: FNB
Account Number: 6293 143 8916
Branch Code: 250 655
Reference: *Name Surname*, Membership
Please upload valid proof of payment*

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INDEMNITY
ACKNOWLEDGEMENT
Should be Empty:

MEMBER DETAILS