VIEWS: 8 PAGES: 1 POSTED ON: 2/14/2011
NORTHERN LIGHTS CHAPTER #5598 2010 MEMBERSHIP ENROLLMENT FORM YOU MUST BE A CURRENT NATIONAL H.O.G. MEMBER TO BELONG TO A LOCAL H.O.G. CHAPTER MEMBER NAME________________________________________________________ ( One member per form ONLY! Please make necessary copies.) Chapter Dues: $20.00 dues for 1st National H.O.G. member @ this address. (Membership 2-1-09 to 1-31-10) $15.00 dues for 2nd National H.O.G. member @ this address. Name Tag: $11.00 (We encourage all members to have & wear nametags.) Optional information: Birth Date: ____________________________________ Anniversary Date:_______________________________ Spouses Name: _________________________________ Do you want to be included in a Chapter Membership Directory? YES NO If the above information has not changed from last year check here please! If you are a new member – How did you learn about Northern Lights H.O.G. Chapter # 5598 ____ Northern Lights Dealership ____ Northern Lights Dealership web site: www.northernlightshd.com ____ Northern Lights H.O.G. Chapter web site: www.northernlightshog.com ____ Harley-Davidson web site: www.harley-davidson.com ____ Chapter member: _______________________________(please include name) ____ Other _________________________________________________________ Make checks payable to: Northern Light H.O.G. #5598 Mail to: Robert Morris Questions about registration: PO Box 235 Call Robert at 715-274-6156 Mellen, WI. 54546 firstname.lastname@example.org PLEASE READ and SIGN RELEASE FORM (separate form) Official use only: Date Rec’d:______________ BY: ______________________ Amount Paid $ _______________ CASH____ CHECK # ____________
"NORTHERN LIGHTS HARLEY -DAVIVSON"