Motorrad Club Namibia Membership – Family

Name: Motorrad Club Namibia Membership - Family - BMW Clubs Africa
SKU: MRNAM-FM
Price: 480.00 ZAR
Availability: InStock

R480,00 for 1 year

Please complete all required* fields.

SKU: MRNAM-FM

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
Street Address*
Street Address Address Line 2 City Province Postal Code
Postal Address
Postal Address 1 Postal Address 2 City Province Postal 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
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?
Please Specify*
Additional Reference, Dealership Name. Club Member Name, etc
Participation in Club events are undertaken on a voluntary basis and at own risk*
- I Agree