Corc membership Application Form 2013

CORC Membership Application Form 2013 Online registration for most memberships can be done at www.registernow.com.au/mtba/ Forms can be: - handed to a committee member at most CORC events - posted to Membership CORC PO Box 667 Civic Square ACT 2608 - scanned & sent by email to [e-mail]

1. 
   Personal details
   

Name: _______________________________________________________________________________________
Address: ______________________________ Suburb: __________________ State: _______ Postcode: ______
Phone: (h) ________________________ (w) ________________________ (m) ________________________
Date of Birth: _ _ / _ _ / _ _ _ _ Sex: Male / Female email: _____________________________________________

2. 
   Application type: New CORC member Renewing CORC member (number) ______________________
   

3. 
   Select membership type (please refer to descriptions and terms on reverse page)
   

1	Senior competition		$20 CORC membership + $110 MTBA membership	$130
2	Junior competition (13-18yo)		$10 CORC membership + $76 MTBA membership	$86
3	DirtMaster competition (3-12yo)		$10 CORC membership + $30MTBA membership	$40
4	Social / non race		$10 CORC membership + $45 MTBA membership	$55
5	CA / BMXA value add option		$20 CORC membership + $55 MTBA membership CA / BMXA Membership #:	$75
6	Permit rebate scheme (PRS) Senior		$20 CORC membership + $80 MTBA membership	$100
7	Permit rebate scheme (PRS) Junior		$10 CORC membership + $46 MTBA membership	$56
8	Family of existing CORC member		Pay applicable MTBA membership only Family member Name: MTBA #:	$110 /$76/ $30
9	CORC membership only - for existing MTBA member		Club: MTBA #: Expiry:	$25

I apply for membership of / would like to renew my membership of Canberra Off-Road Cyclists (CORC). I agree that CORC reserves the right to accept or reject new and renewing membership applications at the sole discretion of the CORC Committee. If accepted, I agree to abide by the rules of the association and I have read and understood the MTBA waiver on the reverse of this page.

4. 
   Member signature: _______________________________________________ Date: _ _ / _ _ / _ _ _ _
   

If you are under 18 years of age, this form must also be signed below by a parent or guardian.
Parent / guardian signature: _______________________________________________ Date: _ _ / _ _ / _ _ _ _

I certify that the application has been received by CORC and that proof of the applicant’s date of birth has been sighted.

5. 
   Club officer: _____________________________ Signature: _________________ Date: _ _ / _ _ / _ _ _ _
   

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6. 
   Payment details
   

Amount: $ _____ Payment method: Cash EFTPOS Cheque Money Order Visa MasterCard
Card number: __ __ __ __ | __ __ __ __ | __ __ __ __ | __ __ __ __ (CVN: __ __ __) Expiry: __ __ / __ __
Name on card: ________________________________ Signature: _______________________________
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www.corc.asn.au

Membership receipt Produce this at events until your membership card is received from MTBA (allow approximately 6wks). Go to our website for information on news, events, clothing, items for sale and much more. Member Name: ___________________Club Category:___________ Date of Birth: _ _ / _ _ / _ _ _ _ Club Officer: ______________________Signature: _________________ Date: _ _ / _ _ / _ _ _ _

Description of membership types and terms

CORC reserves the right to accept or reject new and renewing membership applications at the sole discretion of the CORC Committee.

New Members: If you post this form to CORC, please attach a photocopy of your driver’s license, passport, birth certificate or other proof of age.

1	Senior Competition *	Allows for a member to contest any MTBA sanctioned race in Australia. Age determination is made at the time of application.
2	Junior Competition (13-18yo)*	As above.
3	DirtMaster Competition (3-12yo)*	As above. This class of membership may have some restrictions to the type or extent of competition available.
4	Social / Non Race*	This membership class is for people who do not intend on racing but who wish for the insurance cover offered by MTBA for our members. This class of membership is strictly non-competitive, so members of the class who wish to enter a race will also need to pay for a day permit.
5	CA / BMXA Value Add Option*	Applicable to existing CA and BMXA members with more than three months membership remaining. Please attach a photocopy of your CA licence (not card) or BMXA membership card or application receipt.
6	Permit Rebate Scheme (PRS) Senior	For any non-member who applies for membership and who has participated in a MTBA sanctioned event three times in 12 months prior to the date of membership application. You must provide copies of three day permit forms (or emailed online transactions) in your name.
7	PRS Junior(13-18yo)	As above for 13-18yo
8	Family of existing CORC Member	Applicable to immediate family members of an existing CORC member. Select Senior, Junior, DirtMaster or Social and only pay the MTBA Membership - do not pay the CORC component.
9	CORC membership only existing MTBA member	Applicable to current members of MTBA affiliated clubs. If by post, please attach a photocopy of your MTBA card. CORC membership is valid until MTBA expiry.

*available online at www.registernow.com.au/mtba/