Membership Application Form

Age:

Full Name:

Location:

Contacts

Phone:

Mob:

E-mail:

Fax:

Membership Type

RIDER ( )   CLUB MEMBER ( )  

Bike:

Years Riding:

Web page questions (Riders Only)

Tricks:

Dream Trick:

Hero's:

Music:

Hobbies:

Note: The waver form must be signed before any riding can happen

Signed   __________   (Under 18's need a parent to sign)

Parent   __________

Date     __________

FEE ONLY $35 per year this also includes your public liability insurance.

Details Kaiden Brill 0428749368

Post all moneys to Kaiden Brill PO BOX 43 Scottsdale 7260 TAS

Or sign up in person at Moto Central 57 George St L’ton