Test

Membership runs from 1st April 2015 to 31 March 2016

  • Membership is made up of $20 per individual, or $25 for a whole family at that same address.
  • The membership fee is to cover track development and maintenance, administrative costs, and MTBNZ affiliation and insurance fees.

    Membership Application / Registration Form

     

    Principle Member - Fee $20

    1. First Name (required) Surname (required)
    2. Other Members at Same Address - Fee +$5
      e.g. Dad, Mum and two children = $25
    3. First Name 1 Surname 1
      First Name 2 Surname 2
      First Name 3 Surname 3
    4. Your Address (required)
    5. Town (required)
    6. Postcode
    7. Email (required)
    8. Phone Number
    9. Mobile Number
    10. Emergency Contact Person Name
    11. Emergency Phone
    12. Please add me to Email List YesNo
    13. Please add me to Discussion Group YesNo
    14. Interest survey - please tick activities you are interested in: XC / technicalBackcountry epicsGravel road / 4wd tracksXC racingDownhillFreerideDH racingRoadTrack buildingTrips awayOther
    15. If you chose other, please explain below
    Membership Fees

     

    Total to Pay: (required)

    Please indicate Payment Method Used: (required) Direct Debit/Online BankingCheque / Cash

    Pay into Bank Account:
    South Canterbury Mountain Bike Club Inc
    Westpac a/c: 03-0887-0281375-00
    Please put your name clearly on the transfer details
    (for internet banking, receipt of payment implies acceptance of above conditions)

    Pay by Cheque / Cash
    Post to:
    South Canterbury Mountain Bike Club
    PO Box 40
    Timaru, 7940

     

    Terms

     

    Declaration: I accept that cycling can sometimes be dangerous, and I agree that I participate in club activities at my own risk. I understand that my personal information will be entered into the club database and will be used for a club mailing list. It will not be forwarded to third parties.

    Date: (required)

    ** By checking this box you are authorising your signature in digital format. (required)
    (The form will not register unless you agree).