Membership

Bike SA Membership

Membership Type*
Please enter a valid concession card number*
Are you renewing your Bicycle SA Membership*
Please enter you Bike SA membership number **
First Name **
Last Name **
Date Of Birth **
Date Format: DD slash MM slash YYYY
Address **
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone **
Email **
Emergency Contact Name **
Emergency Contact Number **
Terms & Conditions **
- I agree to the Terms and Conditions
I agree to be bound by the Constitution, Rules and Policies of Bicycle SA. I/We understand that I/we will be placed on the Bicycle SA mailing list and if at any time I/we wish to unsubscribe I need to phone 08 8168 9999. I/We give full permission to use any photographs taken during a Bicycle SA related event for any purpose in promoting activities.
House Hold Members
You can list up to 6 household members as part of your membership (Maximum of Two Adults)
How many additional people would you like attached to your household membership **
Additional Member 1
First Name*
Last Name*
Date Of Birth*
Date Format: DD slash MM slash YYYY
Additional Member 2
First Name*
Last Name*
Date Of Birth*
Date Format: DD slash MM slash YYYY
Additional Member 3
First Name*
Last Name*
Date Of Birth*
Date Format: DD slash MM slash YYYY
Additional Member 4
First Name*
Last Name*
Date Of Birth*
Date Format: DD slash MM slash YYYY
Additional Member 5
First Name*
Last Name*
Date Of Birth*
Date Format: DD slash MM slash YYYY
Additional Member 6
First Name*
Last Name*
Date Of Birth*
Date Format: DD slash MM slash YYYY

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Total

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Bike SA Membership

House Hold Members

Additional Member 1

Additional Member 2

Additional Member 3

Additional Member 4

Additional Member 5

Additional Member 6