6 Tainui Road 96 Barrack Road
Howick Mt Wellington
Ph: (09) 535 6120 Ph/Fax: (09) 570 5989
Fax: (09) 576 3661 e-mail: firstname.lastname@example.org
Membership Registration Form http://eastcitybmxnz.tripod.com
Welcome to East City BMX Club
Registration Fees Full Licence for 20” & Cruiser:
1 rider per family $85
2 riders per family $170
Additional riders per family $70 each
Registration Fees Novice Licence
1 rider per family $50
2 riders per family $100
Additional riders per family $35
New members MUST show a copy of their Birth Certificate. Make cheques payable to East City BMX Club.
Parents/Guardians Names __________________________________________________________
Phone ______________________________ Fax _______________________________________
Mobile No. ___________________________ E-mail _____________________________________
Rider’s name/s Date of Birth Bike No. Licence No.
Parent/Guardian supervision is required for all children at club nights. Total Fee enclosed: $ ___________
Disclaimer: East City BMX Club will take no responsibility for personal injury, damage to property or theft of bicycles or property incurred while at the Merton Road Reserve. Parents will be liable for any damage caused by their children to the premises on Merton Road Reserve.
Signed by Parent/Guardian __________________________________________
Parent’s Information: Can you please help the Club with your skills?
Can you help with any of the following? (1) BBQ roster_____ (2) Lawn mowing roster_____
(3) Working bees_____ (4) Help on Club nights_____ (5) Committee member _____
Do you use and check Email regularly? Daily____ Weekly____ Occasionally____ Never____
Please return registration forms to the Treasurer: Sue Simpson, 6 Tainui Road Howick
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