CCC New member application form

New member application form

This form is only for new members to join the CCC, or existing members re-joing after years away. If you are renewing your membership please use the renewal form here: https://form.jotform.com/242207505255854
Please note - payment is required for this application to be actioned. See bottom of form for details.
Members returning after a few years away can also use this form to confirm details, note previous member number in the box here if known
Name*

First NameLast Name
Known As
Date of Birth*

MonthDayYear
Date
Gender*

MaleFemaleOther/Prefer not to answer
Postal Address*

Street Address

Street Address Line 2

CityRegion

Post CodeCountry
Cell Number*

Area CodePhone Number
Home Phone Number

Area CodePhone Number
Email *
example@example.com
Occupation*
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
DECLARATION: By submitting this form I agree to abide by and be bound by the Constitution, By-laws, Rules and Policy of the Canterbury Car Club Inc. if this application to become a member is granted. I declare that this information supplied by me is true and correct and I consent to the collection, retention, use and disclosure of it by the Canterbury Car Club Inc. for the lawful activities of the Club. My consent is given in accordance with the Privacy Act 2020.
Please note, if you are also applying for or renewing a Motorsport NZ competition licence, this information does not automatically transfer to their database. You must manually update your membership number and expiry date.
Video guide here: https://www.youtube.com/watch?v=VU5oKqxosOM

Once you update your details with MSNZ we have to approve the details you have submitted to them are correct. Please contact us if this is urgent or you do not get confirmation with 2 working days.
Membership application will processed once this form AND payment have been recieved. No invoice is sent unless requested.

Membership Fee:
$70 for all members

Membership is valid for one year

Continental Rennsport requires an additional approval to become a member, please also submit their member form
Payment Options:

- Bank Transfer to Canterbury Car Club 02 0865 0020166 25

- Credit/Debit card in person at CCC office or by phoning 03 349 6003 9-5 weekdays

- Optional online payment below (price includes $2 transaction fee)

My Products

Canterbury Car Club Inc Membership

$72.00NZD

Total

$0.00NZD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty: