Your Chapter
Select the Chapter that you want to join (required)Auckland ChapterSouth Island Chapter ChristchurchHauraki ChapterManawatu ChapterWellington ChapterDeep South ChapterNelson, Marlborough and West Coast ChapterJana Greissner

Applicants Details

Your First Name (required)

Your Last Name (required)

Your Date of Birth (required)

Your Address (required)

Contact Details

Your Home Phone number

Your Work Phone number

Your Mobile Phone number (required)

Your Email (required)

Casualty Next of Kin

Name (required)

Relationship (required)

Contact Number (required)

Other Information

Motorcycle type and CC rating (required)

How long have you been riding (required)

Your Shirt Size (required)

(The above information will only ever be used for club business)

Military Service History

Service (required)
RNZNNZ ArmyRNZAFOverseas
Country and Service (if overseas)

Enlistment Date (required)

Discharge Date (leave blank if still in service)

Service Number (required)

Highest Rank (required)

Branch/Trade/Corps (required)

Current Unit (if applicable)

Awards/Citations/Medallic recognition e.g. OSM, NZGSM and Clasp, LSGCM, etc

Associations with any other motorcycle clubs

Club Name(s)

Club Location(s)

ANY other matters of which the Club should be aware

Please upload a copy of your drivers licence
Front of Drivers Licence

Back of Drivers Licence
Declaration
I declare that ALL of the information I have supplied here is true and accurate. If accepted as a nominee and subsequent member of the Patriots DFMC NZ I promise to abide by the spirit and rules of the Club at all times. I also accept that my association with the Club may be cancelled at any time by a majority vote of the full Chapter.
Signature
Please Type Your Full Name to indicate your Signature(required)