Canterbury Off Road Club Registration

Canterbury Off Road Club Registration

MEMBERSHIP FORM 2025
Personal Details
Your Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Date of Birth (If under 18)

DayMonthYear
Date
Are you a First Aider

YesNo
Emergency Contact Person

First NameLast Name
Emergency Person Phone Number

Area CodePhone Number
Relationship to Emergency Contact Person
From time-to-time CORC requires access to trades to help support and maintain the club i.e. Electrician, Painter, Mechanics, Machinery operators trades etc. Please let us know here if you could be of assistance
Vehicle Details
Your ORANZ Number
Class:
Frame:
CC Rating
Sponsors:
Membership Fees
Membership Fees must be paid by 28th February 2023 to hold your ORANZ number.
Membership Fees (Tick all that apply and select quantity)*
prevnext( X )
ORANZ Membership $250 + CORC Driver Membership $100
$350.00NZD



Junior Truck ORANZ Membership $75 + CORC Driver Membership $25
$100.00NZD



Social Member CORC
$25.00NZD



Change Class
$20.00NZD



Additional Class
$20.00NZD



Total

$0.00NZD
Pay using online banking to: 03-1593-0018939-00

All racing members must be ORANZ registered and must be a financial member prior to your race vehicle being tagged at any club. You are a member once payment has been received.
Agreement
As a condition of agreement below and filling in this membership application, I guarantee to support the aims of Canterbury Off-Road Club Inc. while my membership is active. I accept and agree to follow the Club's Constitution. I consent to Canterbury Off-Road Club Inc. holding and using my details for promoting and running off-road events and for legal and administrative purposes, in accordance with the Privacy Act 1993. I acknowledge my right to access and correct this information.*

Yes, I agree
Date Completed*

DayMonthYear
Date
Should be Empty:

Canterbury Off Road Club Registration

Personal Details

Vehicle Details

Membership Fees

Agreement