Membership Application

Do you Accept the Terms and Conditions?
[radio* TermsandConditions label_first default:1 "Yes" "No"]

First Name (required)

Last Name (required)

South African ID Number (required)

At the date of making this application are you younger than 18 years of age
[radio* Under18 label_first "Yes" "No"]

If you answered yes to being under 18 years of age please provide the contact details for your parent or legal guardian

Contact e-mail address (required)

Contact Number (required)

Alternate contact number (required)

Domicile city or town (required)

What type of membership are you applying for?
---Full Local, 1st Family Member R1650Full Local, 2nd Family Member R1000Full Local, Every Additional Member R800Country Membership, 1st Family member R1000 (persons residing more than 200km from Aldo Scribante)Country Membership, Every Additional Family Member R750 (persons residing more than 200km from Aldo Scribante)New Member 1st Year R900Drag Racing R500Spinning R500Enduro/Off Road Motorcycles R500Rally/Offroad Cars R500Social R500Officials/Honory R0

Name and Surname of Main Member

What class of circuit racing do you plan to primarily take part in? (required)
---Circuit – Sports & GT CarsMSA National Status EventsModified Saloon CarsHistorics and Classic CarsMotorcyclesMarque and Street CarsNon Circuit RacingOfficialSpinningDragsEnduroRally

How are you going to pay your fees? (required)
---EFTCardOfficials

Payment Date (required) e.g.2018/01/08