Port Macquarie Bodyboarding Member Registration

First Name

Last Name

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male female

Date of birth

Street Name and Number

Town or City

Postcode & State

Mobile phone

Email Address

Division ($30 of your fee goes towards mandatory insurance under Surfing NSW & Australia)
Open Mens - Over 18 ($130) Masters - Over 35 ($130) Juniors - Under 18 ($80) Open Womens (FREE) Grommets - Under 13 (FREE)

If you have a valid active kids voucher, please enter it here and we will refund your payment once we have validated it

T-Shirt Size
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Your gender

Nationality

Please type your full name below to confirm that you agree to be bound by the terms and conditions of this competition

State

PMBA INC Membership Application Form

Registration Form

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