Northern Regions Trials Club

NORTHERN REGIONS TRIALS CLUB
MEMBERSHIP APPLICATION

Riding class: Club, Intemediate, Expert, Master

Riding Number:

First name:

Surname:

ID:

Address:

Cellphone:

Email:

Next of kin name:

Next of kin cellphone:

MSA number: (if you have one)

Bike type:

Medical aid name:

Medical aid number:

Tick if student / scholar:

Amount to pay by EFT:

All members should contribute to the club in some way, please indicate how you will help:
Example: Family observer, setting trials, orientate new riders, finding new venues, national sponsorship, marketing, supplying 1Kg borewors after a trial, flag/bunting collection, etc

I will help by:

Notes:
You must hold an MSA Trials licence from MSA to participate, other MSA licences are not accepted.
We will use the above information to pre-print your membership form for you to sign at the trial.