Membership Application Form

First Name:
Surname:
Phone:
Mobile:
Email:
Street Address:
Suburb:
Town/City:
Occupation Type:
Membership Type:
MNZ Number:
	I agree to my details being published in 'Cycle Torque' magazine
or
Note:	If Emailing please deposit your Membership Fee (Senior $40.00 - Junior $20.00 (14 & under) into Ixion's Account using Internet Banking. IXION MOTOR CYCLE CLUB - Account No. 03 0502 0068232 00 Your form will not be proccessed until fee has been paid.
Fee: Senior $40.00 - Junior $20.00 (14 & under)
	Please post, along with your Membership fee, to... Ixion Motor Cycle Club P.O. Box 57127 Mana