Renewal Form - Manawatu Blokart Club

Club Membership Renewal (2022/ 2023)

Name *

First

Last

Email *

Date of Birth *

Gender

Street Address

Town / City

Home Phone

Cell Phone

Emergency Contact *

First

Last

Emergency Contact Number

Existing Member

Membership Type *

Individual ($120)
Youth (under 19 at 1st of April) ($40)
Associate (Non sailing or full member of another BAI affiliated club) ($30)
Family (fill in names below) ($200)
Youth Academy ($40) (fill in name and guardian below)
Immediate past Capital Blokart club member. ( No fees 2022-23)

Note: Full adult club membership is $120 which includes unlimited track use (adult membership plus casual track fee is no longer an option) Family membership includes track fees as well.

Paying by Internet Banking? (15 3977 0010775 00)

Pulley Whip Number

Name