DSMRA
 

--DSMRA REGISTRATION FORM:

This registration form registers you as a DSMRA website user with restricted 'guest' permissions. To become a full DSMRA member you must complete this form - then pay via options offered.

IF PLANNING TO JOIN/PAY: This form by default, lists branches that may no longer be active.

Please ensure you go to the DSMRA CONTACT's section to check if a DSMRA branch is active near you.

SINGLE MEMBERSHIP (or 1st rider in Family Membership)
*Online User Name:
*Password:
*Mbr1.First Name:
*Last Name:
 
FAMILY MEMBERSHIP (allows a 2nd nominated rider plus 3 x non riding members from same residence)
2nd NOMINATED RIDER: (leave blank if 2nd rider is not applicable in your house)
 
Mbr2. Full Name:
2nd rider (licensed only)
NON RIDERS:---------------------------------------------
 
Mbr3. Full Name:
non riding
 
Mbr4. Full Name:
non riding
 
Mbr5. Full Name:
non riding
CONTACT DETAILS
Addr Line1:
Addr Line2:
*Suburb:
*
*PCode:
Country:
DOB:
*Phone:
Mob:
Fax:
   
*Email Addr:
------------------------------A confirmation email will be sent to you to complete this registration..
   
Skype:
Emerg Cont Pers:
Phone:
Contact Me By: -Ph   -Mob   -Email   -Skype   -Yahoo   -MSN  
*Contactable: Yes No
   
My Closest Branch:
  This dropdown list may not necessarily represent 'active' branches - please check contacts page first before joining.
   
Notify Me About New Rides
Yes No
   
Promo (if applicable)
 
PAYMENT CHOICE
Payment Method:
Paypal   Bank   Credit Card   Cheque  
 
CONFIMATION
 

CAPTCHA:

Please type what you see in this box -If you are unsure, you can hit the audio button (right top corner within this box) to help read the code to you.

Reload Image


 

I have read and agree to the Terms of Use and   Privacy Policy of DSMRA