UsernameEmail* Password* Enter Password Confirm Password Full Name* First Last Date of Birth* Postal AddressTown*ID/Passport Number*Cell*Telephone HomeEmergency Contact Name*Emergency Contact Number*Medical Aid NameMedical Aid NumberBlood GroupUnknownO+O-A+A-B+B-AB+AB-AllergiesMembership InformationMembership Type*Day Rider - N$250 (per race registration only)Full Member - N$700Under 18 Member - N$450Family - N$1400 (max 4 members)CategoryPro Elite Men: 19-29Pro Elite Women: 19-29Junior Men 17-18Junior Women 17-18Sub-vet Men: 30-39Sub-vet Women: 30-39Veteran Men: 40-49Veteran Women: 40-49Rhino Men (>90kg)Giraffe Women (>70kg)Master Men: 50-59Master Women: 50-59Grand Master Men: 60+Grand Master Women: 60+Junior Men: 17-18Junior Women: 17-18Under 16 Boys: 15-16Under 16 Girls: 15-16Under 14 Boys: 13-14Under 14 Girls: 13-14Under 12 Boys: 11-12Under 12 Girls: 11-12Sprogs Boys: 10 and youngerSprogs Girls: 10 and youngerMarathon MenMarathon WomenE-Bike MenE-Bike WomenFirst and Surname of Main Member*Main Member Email If you know email of your Main Member, please type it here. Your account will be automatically connected into Main Member account so the Main Member can see the family members.You can create Child Member under your account. Child Member is members who don't have email account and have Family Membership. You can access this feature after you login to the Dashboard.Payment viaEFTPayTodayCashPlease send POP to firstname.lastname@example.orgPayment Date Indemnity* I have read and agree to the terms and conditions of the indemnity agreement. Constitution Read* I have read and agree to the constitution Mailing List (optional) I want to receive updates from Rock & Rut Membership Code* Your membership request will be sent to admin for verification.NameThis field is for validation purposes and should be left unchanged.