Membership Application Form

Transponder #:
First Name:
Last Name:
Address:
Apt #:
City:
Province:
If other above:
Postal Code:
Date of Birth:
Age:
Email Address:
Cell Phone:
Evening Phone:
Motorcycle Year:
Motorcycle Make:
Motorcycle Model:
Requested Bike # 1st Choice:
Requested Bike # 2nd Choice:
Requested Bike # 3rd Choice:
Sponsors:
I would like to receive information
from MMRS Sponsors
Motocross
Please Select Your Classes:
Girls 4-8 50cc
50 4-6
50 7-8
50 GP
60 10-11
60 7-9
60 GP 7-11
80 12-16
80 7-11
Supermini 9-16
Open Intermediate
250 Intermediate
Cash Class (Inter. Allowed)
Open Junior
250 Junior
Open Beginner
Youth (14-29) Int/Pro
Youth (14-29) Beginner/Junior
Schoolboy 12-17
MX Tykes (Non-racers, after Sat. Practice)
Vet 25+A
Vet 25+B
Vet 40+A
Vet 40+B
Vet 50+
Ladies A 12+
Ladies B 12+
Girls 9-16
2 Stroke 125-150 12+

Pay by Paypal
Membership Plan:
reCaptcha Code
MEMBERSHIP FEE
1 Year Membership SINGLE $100.00 (HST included)
  FAMILY* $160.00 (HST included)
* Family includes all immediate family members 18 years or under, students 18 years - 21 years.
 
Payment can be submitted by
CHEQUE Make cheque out to: MMRS
Mail to:
M.M.R.S.
J. Maguire
1224 Centreton Rd.
Grafton, ON
K0K 2G0
CASH Please bring cash payments to us.
PAYPAL / DEBIT / CREDIT CARD Pay with PayPal/Debit/Visa/Mastercard via PayPal
If you do not have a PayPal account, you can click the PayPal link and then select to pay as a PayPal guest.