Membership Registration Step 1 of 2 50% Type of Membership*JuniorSeniorFamilySocial non competitiveSingle or Couple?* Single Couple Name* First Last Person 1* First Last Person 2* First Last Junior First Name Junior Last Name Senior - First Name Senior - Last Name First Name Last Name Add 2nd Adult Yes No 2nd Adult - First Name 2nd Adult - Last Name Add Child Yes No Child #1 First Name Child #1 Last Name Add 2nd Child Yes No Child #2 First Name Child #2 Last Name Add 3rd Child Yes No Child #3 First Name Child #3 Last Name Add 4th Child Yes No Child #4 First Name Child #4 Last Name Email* Mobile*Postal Address* Street Address Address Line 2 Suburb State Post Code Credit Card*Card Details Cardholder Name Junior Membership Price: Senior Membership Price: Family Membership Price: Social memberships Price: Consent I agreeI hereby agree to abide by the North West MCC Supplementary Regulations and the rules governing the Motorcycling Australia Rule Book. Please note: Membership is due on the 1st of each new year and expires on the 31st of December of the same year. Membership must be paid before any competitor can race. IMPORTANT NOTE: Completing this membership form and making payment does not automatically entitle you to membership of this club. The committee has the right to reject your application without reason.NameThis field is for validation purposes and should be left unchanged.