Mountain Bike Australia Payment Fee Summary Sheet Effective as of 1 July 2019

Name of Club/Promoter: Date: *** PLEASE ENSURE CORRECT FUNDS ARE ENCLOSED TO AVOID PROCESSING DELAYS ***

Race Membership

Masters 7+ (60 years & over) – 12 months $102.00 $

Masters 7+ (60 years & over) – 3 months $43.00 $

Adult (19 – 59 years) – 12 months $140.00 $

Adult (19 – 59 years) – 3 months $63.00 $

Adult Value Add – CA/BMXA/ADCC – 12 months $102.00 $

Junior (13 – 18 years) – 12 months $102.00 $ Junior (13 – 18 years) – 3 months $43.00 $

Junior Value Add – CA/BMXA/ADFC – 12 months $80.00 $

Dirtmaster (7 – 12 years) – 12 months $49.00 $ Dirt Cub (2 – 6 years) – 12 months $25.00 $

Recreation Membership (with Club) Masters 7+ (60 years & over) – 12 months $49.00 $ Masters 7+ (60 years & over) – 3 months $25.00 $ Adult (19 years & over) – 12 months $69.00 $ Adult (19 years & over) – 3 months $36.00 $

Junior (13 – 18 years) – 12 months $49.00 $ Junior (13 – 18 years) – 3 months $25.00 $

Non-Rider Membership Non-rider member – 12 months $52.00 $ Non-rider member – 3 months $25.00 $ Public Liability Membership Public Liability member – 12 months (with Club) $35.00 $

Public Liability member – 12 months (no Club) $56.00 $ Race Event Licence & Recreation Permits

Race Event Licence

Race Event Licence

Adult (19 years & over) – Recreation permit $10.00 $ Junior (3 – 18 years) – Recreation permit $7.00 $

Mass Participation Event Licence 200+ riders Valid for pre-approved events ONLY

$7.00 $

Affiliation Club annual affiliation fee $185.00 $

School annual affiliation fee $185.00 $

Other $ $ Total Payable $

MTBAMembershipType Fee No.ofForms TotalFee

1-100sold(perevent)

TotalMoniesreceived

AmttoremittoMTBA=TOTALless25%Clubshare

101-500sold(perevent)

TotalMoniesreceived

Adult:Qtysoldat$36

Junior:Qtysoldat$22

Recupgrade:Qtysoldat$15

ElectronicFundsTransferDetails

Bank:CommonwealthBankofAustraliaAccountname:MountainBikeAustraliaLtdBSB:064475Accountno:10375364

EFTRemittancedetails

DatePaid:_________________AmountPaid:______________Reference:________________

Adult:Qtysoldat$36

Junior:Qtysoldat$22

Recupgrade:Qtysoldat$15

Paymentoptions

ChequeDetails

MakechequespayabletoMountainBikeAustralia

FullamountofpermitstoberemittedtoMTBA

AmttoremittoMTBA=TOTALless40%Clubshare