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NORTHERN LIGHTS HARLEY -DAVIVSON

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					                             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                    robert950@centurytel.net

        PLEASE READ and SIGN RELEASE FORM (separate form)



                                       Official use only:       Date Rec’d:______________ BY: ______________________

                                       Amount Paid $ _______________             CASH____          CHECK # ____________

				
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