Register Child Member - Rock n Rut Mountain Bike Club

Your Email (Main/Parent Member)*

Child Member can be registered and managed by Main/Parent Member

Username*

Please create username, child member can login with only username and password without email.

Generated Email*

Password*

Enter Password Confirm Password

Full Name*

First Last

Date of Birth*

Postal Address

Town*

ID/Passport Number

Cell

Telephone Home

Emergency Contact Name*

Emergency Contact Number*

Medical Aid Name

Medical Aid Number

Blood Group

Allergies

Membership Information

Membership Type*

Category*

First and Surname of Main Member*

Proof of Payment

Payment via

Payment Date

Indemnity*

Constitution Read*

Mailing List (optional)

Membership Code

* Your membership request will be sent to admin for verification.

Name

This field is for validation purposes and should be left unchanged.