New Member Registration - Rock n Rut Mountain Bike Club

Username

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*

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 via

Please send POP to accounts@rockandrut.org

Payment 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.

Name

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