Name *

First Name

Last Name

(Family pass) Child 1 Name

First Name

Last Name

(Family Pass) Child 2 Name

First Name

Last Name

Phone

(###)

###

####

Date of Birth

MM

DD

YYYY

Membership fee *

Annual Club Membership Fee $70.00

Family Membership (1 Adult & up to 2 Children 18 years and under as of 1st Jan 2025) $95.00

Junior Membership (18 years of age and under) $35.00

*

I agree to abide by the General Rules and Constitution of NHRCCC and NZRCA.