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Member Details

Title

First Name*

Last Name*

Date Of Birth*

Sex

Email*

Alternate Email1

Alternate Email2

Residential Address

Address

Suburb

Country

State

Post Code

Home Phone

Mobile*

Mailing Address

Address*

Suburb*

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State*

Post Code*

Work Phone Ext.

Fax No.

Other information

MQ Officals Status *

MQ Licence Number

Do you hold a Blue Card (working with children)? *

Yes

If Yes, please provide card number and expiry date

Do you hold a First Aid Certificate? *

Yes

If Yes, please provide expiry date

Membership Fees

Family (2 Adults and up to 6 Children) - $50.00

Single (Senior) - $30.00

Single (Junior) - $15.00

Email address is already assigned to a member,
please use an alternative email address.

You appear to be an existing member.
Do you want to renew your membership?

Primary Member must be an Adult/18+. Children/under 18 memberships can be added on the next page.

Aged pension membership is for members over 65 years.
Please choose another membership type or correct your date of birth.

EA number does not match member name.

To be eligible for this membership, a doctors certificate/para classification/RDA associate membership must be provided to the club to receive a code to apply for this membership type. Please type code in below.

Tablelands Enduro Riders Association

Member Registration

Member Details

Residential Address

Mailing Address

Other information

Membership Fees