Buckeye Beemer’s Motorcycle Club
Application Form
Name:
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Street address, city, state and state
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Home Phone: ( )
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Work Phone: ( )
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Optional
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Cell: ( )
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E-mail:
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Optional
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Motorcycles owned:
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1
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2
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3
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Associate Name and address (if not same)
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Circle club below
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AMA #:
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BMWMOA #:
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BMWRA #:
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Please circle interests (and list other interests)
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Rallying
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Touring
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Camping
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Dinner Rides
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Breakfast Rides
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Sidecars
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Racing
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Vintage MCs
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Dues: New Member $35. Renewal $35. New Assoc. (Related to member) $5, Renewal Assoc. $5. Term Jan. 1 through Dec. 31. All dues due by Jan 31.
Make checks (membership fee only) payable to BUCKEYE BEEMERS M/C Club and Mail to Buckeye Beemers, 5405 Infinity Court, Grove City 43123.
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
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Date
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Associate's Signature
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Date
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..
Thanks For Your Membership