Name: Motorrad Club Lowveld Membership - Family
SKU: MRLWV-FM
Price: 500.00 ZAR
Availability: InStock

Personal

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 Postcode

Please ensure this is accurate for postage purposes else you won't get your magazine or membership pack

Postal Address

Postal Address 1 Postal Address 2 City Province Postcode

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*

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Show cars if ctype=car OR ctype=NULL

Toggle for CarClubs vs Motorrad Clubs, vs Clubs that may offer both ctypes.

Car/s

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*

Number of Cylinders*

Aspiration*

Tyre Make*

E.g. Bridgestone, Good Year

Tyre Type*

Do you have additional cars to add?

Vehicle #2

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

Year of Manufacture

E.g. 1996, 2007

Engine Capacity

Number of Cylinders

Aspiration

Tyre Make

E.g. Bridgestone, Good Year

Tyre Type

Vehicle #3

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

Year of Manufacture

E.g. 1996, 2007

Engine Capacity

Number of Cylinders

Aspiration

Tyre Make

E.g. Bridgestone, Good Year

Tyre Type

Vehicle #4

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

Year of Manufacture

E.g. 1996, 2007

Engine Capacity

Number of Cylinders

Aspiration

Tyre Make

E.g. Bridgestone, Good Year

Tyre Type

Vehicle #5

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

Year of Manufacture

E.g. 1996, 2007

Engine Capacity

Number of Cylinders

Aspiration

Tyre Make

E.g. Bridgestone, Good Year

Tyre Type

Hidden

Show bikes if ctype=bike OR ctype=NULL

Bike/s

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

Make

E.G BMW

Model

E.g. R1200GS,K1300S etc

Year of Manufacture

Registration Number

Do you have additional bikes to add?

Bike #2 Make

Bike #2 Model

Bike #2 Year of Manufacture

Bike #2 Registration Number

Bike #3 Make

Bike #3 Model

Bike #3 Year of Manufacture

Bike #3 Registration Number

Bike #4 Make

Bike #4 Model

Bike #4 Year of Manufacture

Bike #4 Registration Number

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Section Break

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

Product Name

Total

R0.00

Motorrad Club Lowveld Membership – Family

Show cars if ctype=car OR ctype=NULL

Show bikes if ctype=bike OR ctype=NULL

Section Break