Green Knights Military Motorcycle Club Membership Application Form by suchenfz

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									                                                             Dues Paid: $ ____________




                        Green Knights Military Motorcycle Club
                             Membership Application Form

Personal Information:
Name: Last __________________________ First _____________________M.I. _____
Residential address________________________________________________________
                          Street             city                    state             zip

Home: (_____)_______________________ Work:.(______)_______________________
Cell: ______________________________ Email Address ________________________
Other e-mail (.mil or other govt. e-mail address requested): _______________________
Military affiliation (Military [Active/Guard/Reserve], dependent, contractor): _________
Unit/Company: ________________________________

(Primary) Bike Information:
Type (circle one):         Cruiser       Dirt        Motocross Sport     Other
Year: _____ Make: __________________ Model: _____________ Engine size: _____cc
Do you currently own more than one bike?           Y       N
If yes, briefly describe (as above) the other bike(s):
________________________________________________________________________

Rider Information:
Years of riding experience (circle one):    0-1     1-3    3-5     5-10               10+
Extra riding courses taken (outside of the MSF Basic RiderCourse™):

1)_____________________________________________________________________
       Name of course                                      Name of school, location

2)_____________________________________________________________________
       Name of course                                      Name of school, location



Mentorship Information:
If qualified, would you be interested in being a mentor?                        Y       N

Would you like to have a mentor?                                                Y      N

I agree to the following statements (Please initial beside each statement):
____The Green Knights Military Motorcycle Club will be in no way responsible for
death, injury, or property damage or property loss.
____ I agree to maintain insurance coverage at all times and provide GKMMC Chapter
20 with any updates to my coverage.
____ I acknowledge the above information is true to the best of my knowledge.

Signature _________________________________ Date _________________________

Emergency contact Name and Phone Number:__________________________________


                                       Thank you!

								
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