Membership Form


Bay Of Plenty Lawn Mower Racing Club (inc)


MEMBERSHIP FORM


Full Name………………………………………………………………………………….

Gender M F DOB………./………./……………(if under 18 yrs)

Contact Details

Home PH……………………….Mobile…………………………….Work………………………

E-mail ………………………………………………………………………………………

Address ……………………………………………………………………………………

Emergency contact, Name ……………………………………………………………………………… Phone…………………………

Race number choices 1 __ __ __

Please select your choices 2 __ __ __

You will be contacted if 3 __ __ __

None of your choices are 4 __ __ __

Available 5 __ __ __

Race Number given ……………………….

( Office use only )

 

Signed………………………………………………….

Date ………………………………………

Witness name …………………………………….

Date………………………………………….

Witness Signature……………………………….