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Application for Membership

I do hereby make application for membership to BMX New Zealand, I also agree to comply with all rules and regulations for all activities and understand that I am fully responsible for my actions. I understand that my membership will be valid until the 31st July

each year, and is renewable before the expiry date.

All applicants must fully complete and sign this form before a Licence will be processed


LICENCE NUMBER (All riders racing 20” & Cruiser will be issued with two licences.)

PREVIOUS               FULL                     20”                                         CRUISER                                             

                                                                          ( Please enter CURRENT licence number)


NEW                        FULL                20”                                          CRUISER                                           

                                                                          ( Please leave BLANK for licence co-ordinator )

PREVIOUS                     NOVICE                20”                                         CRUISER                                            

                                                                          ( Please enter CURRENT licence number)

NEW                                NOVICE                20”                                          CRUISER                                            

                                                                          (Please leave BLANK for licence co-ordinator)

FIRST NAME                                                                                 SURNAME                                                                                          


CITY / TOWN                                                                                                                                                                                                               

PHONE (          )                                                                                              FAX (        )                                                                           

Email address                                                                                                                                


SEX                  MALE                    FEMALE                                DATE OF BIRTH                                                          

                                                                                                         (If new licence a copy of birth certificate MUST be produced)

                                                                                                                    (Copy of passport is also acceptable. Don’t send original)

CLUB                                                                                              PLATE NZ #20”                 CLUB #20”                                        


PLATE  NZ #CR             CLUB #CR                              


LICENCE TYPE               FULL                       NOVICE                  UPGRADE                              20”                         CRUISER


ETHNIC ORIGIN               EUROPEAN                          MAORI                   OTHER

                Office Use Only

Date received:                                                                      


Proof of age attached:Yes        No


Signed Rider:                                                                                                

Parent or Guardian if under 16 years old.

Please return this form to your club secretary.                                                                                     OO          


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