MNZ Life Member Nomination Form - Motorcycling New Zealand

Please complete the nomination form below before 28 February for consideration before the AGM of the same year. If you prefer, you can download a PDF form and return it to the MNZ office via post (PO Box 253, Huntly 3740) or email to [email protected].

Life Member Nomination

Nominee's First Name*
Nominee's Last Name*
Nominee's Date of Birth (if known)
MNZ Club (current or past)*
Home Phone
Mobile
Email Address
Reason(s) for Nomination*
Please provide a brief description of the facts supporting this nomination for MNZ Life Membership **
**File Upload
Please upload any documents supporting the nomination (eg photos, news stories, media releases, club records, event results, etc).
Drop files here or

Accepted file types: doc, docx, pdf, jpg, png, Max. file size: 5 MB.
Positions Currently or Previously Held at Club Level*
Positions Currently or Previously Held at MNZ Level*
Personal Achievements/Notable Activities in Motorcycling*
Is the Nominee a Life Member of an MNZ Club(s)?*
- Yes
- No
If Yes, Please Name the Club(s)
Nominated By:*
First Last
Date of Nomination
MM slash DD slash YYYY
I (the nominator) confirm that I am:*
- A full and current MNZ member
- A Club or National grade official
- A current affiliated club President, Vice President or Captain
Phone (nominator)*
Email Address (nominator)*
Seconded By:*
First Last
Affiliated Club (nominator)*
Date Seconded
MM slash DD slash YYYY
I (the seconder) confirm that I am:*
- A full and current MNZ member
- A Club or National grade official
- A current affiliated club President, Vice President or Captain
Phone (seconder)*
Email Address (seconder)*
Affiliated Club (seconder)*
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