Family Membership – Pay by Credit Card / Paypal

First Name *
Last Name *
Street *
Suburb *
State *
Postcode *
Phone
Mobile *
D.O.B. *dd/mm/yyyy
Email *
Do you have a MNSW Race License *
NoYes
MNSW Race Lic No
Expiry dd/mm/yyyy
Heaven Race Number Policy Heaven allocated race numbers are reserved for paid up members only until Feb 28 of the following year. If a member has not renewed their membership by Feb 28 2020, from March 1 their race number is no longer reserved and could be re-allocated to a paid up member.
New Members Most 2 digit Heaven VMX race numbers have been allocated to existing long term members and rarely become available. To discuss available race numbers, after March 1, 2020, please email the committee.
Heaven Race No *
Existing Race Numbers will be reserved for the new year unless otherwise advised. What would you like to do?Keep ExistingApply for a new one after March 1

Note: Family membership is open to an adult or cohabiting adult couple and their dependent children (including foster children and guardian-ships) generally up to 18yrs of age.
First Name *Family member 2
Last Name *
D.O.B. *dd/mm/yyyy
Do you have a MNSW Race License *
NoYes
MNSW Race Lic No
Expiry dd/mm/yyyy
Heaven Race No
Existing Race Numbers will be reserved for the new year unless otherwise advised. What would you like to do?Keep ExistingApply for a new one after March 1
New Members Most 2 digit Heaven VMX race numbers have been allocated to existing long term members and rarely become available. To discuss available race numbers, after March 1, 2018, please email the committee on heaven.vmx@gmail.com as early as possible

Family Member 3
Not RequiredSelect
First Name Family member 3
Last Name
D.O.B. dd/mm/yyyy
Do you have a MNSW Race License
NoYes
MNSW Race Lic No
Expiry dd/mm/yyyy
Heaven Race No
Existing Race Numbers will be reserved for the new year unless otherwise advised. What would you like to do?Keep ExistingApply for a new one
New Members Most 2 digit Heaven VMX race numbers have been allocated to existing long term members and rarely become available. To discuss available race numbers, after March 1, 2019, please email the club on heaven.vmx@gmail.com

Family Member 4
Not RequiredSelect
First Name Family member 3
Last Name
D.O.B. dd/mm/yyyy
Do you have a MNSW Race License
NoYes
MNSW Race Lic No
Expiry dd/mm/yyyy
Heaven Race No
Existing Race Numbers will be reserved for the new year unless otherwise advised. What would you like to do?Keep ExistingApply for a new one after March 1
New Members Most 2 digit Heaven VMX race numbers have been allocated to existing long term members and rarely become available. To discuss available race numbers, after March 1, 2018, please email the committee.

Acknowledgment By submitting this form, we hereby apply for membership of Heaven VMX Inc. for 2019, and agree to be bound by the rules of the association. I as the Senior member am also aware that being a member of Heaven VMX Inc I have a responsibility when requested to avail myself at each race meeting I enter, to be involved in or assist with the running of the meeting as a Flag Marshal or other duty.
Pay by Credit Card / PayPal *
2020 Annual Family Membership - $90.00

So that we know you are human please enter any two digits *Example: Chad Reed's race number 22
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