Membership Application

Annual Membership Type:  (SELECT ONE ONLY)

All memberships are annual memberships.  Dues are payable on March 1st of each year.

8898 Greenock Place

Surrey, BC Canada

V3V 6R9

British Columbia Pocket Bike Racing Association

Street Address

Postal Code

City

Occupation

Email

Home Phone

Work Phone

By Submitting this form I/We agree: To ride responsibly, To wear a helmet & proper safety gear, To promote the sport and To abide by the club’s Constitution & Bylaws.

Name of primary member

Birth date dd/mm/yy

Sex:   M  /  F

Name of family member 1

Birth date dd/mm/yy

Sex:   M  /  F

Name of family member 2

Birth date dd/mm/yy

Sex:   M  /  F

Name of family member 3

Birth date dd/mm/yy

Sex:   M  /  F

Name of family member 4

Birth date dd/mm/yy

Sex:   M  /  F

Name of family member 5

Birth date dd/mm/yy

Sex:   M  /  F

Name of family member 6

Birth date dd/mm/yy

Sex:   M  /  F

Contact Details:

STEP 1: Select the type of annual membership you like.

Note: The associated dues for each type is listed.

STEP 2: Enter the Primary member’s name, sex and birth date. (DD/MM/YY)

STEP 3: Enter all the Family member’s names, sexes and birth dates, only if you chose a Family membership.

STEP 4: Enter your address, phone number and other contact information.

STEP 5: Agree and Submit Membership Application.

BCPocketBikeRacing.ca