Car Club Gauteng Membership – Race Series

Name: Car Club Gauteng Membership - Race Series
SKU: CCGTN-RS
Price: 2000.00 ZAR
Availability: InStock

Please complete all required* fields.

NOTE:

Please use the GENERAL section at the bottom of the form, “Additional References..” field for the below info.

Copy, paste and complete:

Race Series Class:
Racecar Number:
Sponsor:
Tyre Size:

User Car Registration SA

PERSONAL

Name *

First

Last Name *

Last

Email Address *

Enter Email

Confirm Email Address *

Confirm Email

Password *

Eight characters minimum One lowercase letter One uppercase letter One number One special character

Enter Password

Confirm Password *

Confirm Password

Mobile Number

Secondary Phone Number

ID Number

MSA License Number

Address

Street Address

Address Line 2

City

Post Code

Province

Country

Postal Address (optional)

Postal Address 1

Postal Address 2

Postal City

Postal Post Code

Postal Province

Medical Aid Details (Optional)

Medical Aid Company Name

Medical Aid Plan/Type

Membership Number

Medical Aid Contact Number

ICE Details

Your Dr's Name

Your Dr's Phone Number

ICE Contact Name

ICE Contact Phone Number

Primary Vehicle

For now we just need to know what your primary vehicle is. Once you have registered you will be able to add more to your profile

Primary Vehicle

E.g. E46 M3 GTR, Golf V GTi, Skyline R34 GTR

Year of Manufacture

E.g. 1996, 2007

Engine Capacity

E.g 3.0L, 4.0L, 2.0L

Number of Cylinders

Aspiration

Tire Make

Tyre Type

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

If you are human, leave this field blank.