.

.

Name:

 

Associate Name:

 

If
Applicable

Home Address:

 

City:

State:

Zip:

Omit From
Membership
Listing
(   )

Home Phone:

(   )

Work Phone:

Optional

Cell:

Optional

E-mail:

Optional

All Motorcycles owned:

 

AMA #:

BMWMOA #:

BMWRA #:

 

 

Please circle interests           (and list other interests)

Rallying

Touring  

Camping   

Dinner Rides

Breakfast Rides

Sidecars 

Racing  

Vintage MCs

 

Dues: New Member $25, Renewal $25. New Assoc. (same address as member) $5, Renewal Assoc. $5. Term Jan. 1 through Dec. 31

Make checks (membership fee only) payable to BUCKEYE BEEMERS M/C Club and Mail to Buckeye Beemers, P.O.Box 154 Columbus Ohio 43216

I hereby release the BUCKEYE BEEMERS from all liabilities and/or claims that may arise or that I may otherwise receive as a result of my membership or participation in any BUCKEYE BEEMERS sponsored activities.

Applicant's Signature and Date

Associate Applicant's Signature and Date

Updated 09-14-2009

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