GAN BMX Association 2016 Season Membership Rider ...
GAN BMX Association 2016 Season Membership
Rider Information
Name: _____________________________________________ Phone: ___________________________
Address:____________________________________________ City: _____________________________
Province: ___________________________________________ Postal Code: _______________________
D.O.B Yr/Mth/Day: ________/_________/_________ Age: ________ Email: _______________________ (No private information will be shared with any sponsors or partners of GAN BMX Association) Strider ( ) Learn to Ride ( ) Novice ( ) Intermediate ( ) Girl ( ) Expert ( ) Cruiser ( ) Select the type of membership ( ) Under 6 membership – includes all of Gan single point races (BMX Licence Extra)……………………… Free ( ) Regular yearly membership – includes all of Gan single point races (BMX Licence Extra)…….……. $125 ( ) Family Package – Three or more family members, includes all of Gan single point races ……….…. $275 (BMCX Licence Extra) ( ) GAN BMX Secondary membership – members of KBMX, single point races only ………………….…… $90
Total: _________ Paid: _________ If the rider is under the age of 18 years old, parent or guardian signature required ______________________________ Riders Name
___________________________ Parent/legal guardians name
______________________________ Riders Signature
___________________________ Parent/legal guardians signature
Date: _________________________
Date: ______________________
Rider Information
Name: _____________________________________________ Phone: ___________________________
Address:____________________________________________ City: _____________________________
Province: ___________________________________________ Postal Code: _______________________
D.O.B Yr/Mth/Day: ________/_________/_________ Age: ________ Email: _______________________ (No private information will be shared with any sponsors or partners of GAN BMX Association) Strider ( ) Learn to Ride ( ) Novice ( ) Intermediate ( ) Girl ( ) Expert ( ) Cruiser ( ) Select the type of membership ( ) Under 6 membership – includes all of Gan single point races (BMX Licence Extra)……………………… Free ( ) Regular yearly membership – includes all of Gan single point races (BMX Licence Extra)…….……. $125 ( ) Family Package – Three or more family members, includes all of Gan single point races ……….…. $275 (BMCX Licence Extra) ( ) GAN BMX Secondary membership – members of KBMX, single point races only ………………….…… $90
Total: _________ Paid: _________ If the rider is under the age of 18 years old, parent or guardian signature required ______________________________ Riders Name
___________________________ Parent/legal guardians name
______________________________ Riders Signature
___________________________ Parent/legal guardians signature
Date: _________________________
Date: ______________________
