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!
Pages to are hidden for
"Green Knights Military Motorcycle Club Membership Application Form"Please download to view full document