Motorcycle Club Pretoria Membership – Pensioner

R280,00 for 1 year and a R140,00 sign-up fee

Please complete all required* fields.

I hereby apply for Membership to BMW Motorcycle Club Pretoria (BMW MCC Pta).
I agree to abide by the BMW MCC Pta constitution, rules and guidelines.
I will not hold the BMW MCC Pta or it’s committee members, individually or collectively, responsible or accountable for any claims, mechanical or medical, resulting from any cause during an organised, or other, event or ride.
By submitting this application, I agree to the above indemnities and / or points.

Please complete all required* fields.

SKU: MCPTA-PM

Personal
Profile Photo
Max. file size: 5 MB.
Name*
Surname*
Partner Name*
Partner Surname*
Email*
Mobile Number*
Second Phone Number
Only if available
ID Number*
MSA License Number
Type TBA if not yet renewed
Address*
Street Address Address Line 2 City Province Postal Code
Postal Address*
Postal Address 1 Postal Address 2 City Province Zip Code

Please ensure this is accurate for postage purposes else you won't get your magazine or membership pack
MEDICAL & ICE DETAILS
Medical Aid Company Name
Medical Aid Plan / Type
Membership number
The medical aid number
Contact Phone
The phone number of the medical aid
Your Dr's Name
Your Dr's Phone Number
ICE Contact Name*
ICE (in case of emergency)
ICE Contact Phone Number*
General
How did you find out about the club?
Additional Reference, Dealership Name. Club Member Name, etc
Participation in Club events are undertaken on a voluntary basis and at own risk*
- I Agree