• 2019 USO Bike Ride Membership

  • Membership Period: 1st January 2019 - 31st December 2019

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  • Ethnicity:

    Primary Member - Please indicate below your ethnicity:

  • Ethnicity:

    Spouse/Partner ethnicity:

  • EMERGENCY CONTACT

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  • HEALTH INFORMATION

    Primary Member:
  • MEMBERSHIP PAYMENT

  • DIRECT CREDIT PAYMENT TO:

    USO Bike Ride

    BNZ 02-0700-0097632-02

    PLEASE NOTE thIs bank a/c is for Membership Payments Only

    Enter your SURNAME as your reference

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