Membership Enrollment Form:

Name: ______________________________________

Address: _____________________________________

City: _________________ State: ______ Zip: ________

Phone No: Cell/Work No: (include area code)
_________________    ___________________
(Can we call you at work?) Yes _____ No _______

E-mail: ______________________________

D.O.B. _____________________________________

Shirt Size (Circle One)

Small    Medium    Large    X-Large    2XL    3XL    4XL

MEMBERSHIP INCLUDES:

  • DOWNED BIKER EMERGENCY CONTACT

  • MEMBERSHIP CARD

  • T-SHIRT

  • MAILINGS/E-MAIL ON UPCOMING EVENTS

  • 1ST PRIORITY RAPID RESPONSE TEAM AND

  • THE SATISFACTION OF HELPING FELLOW BIKERS.

MEMBERSHIP COST PER PERSON (Circle One)

Individual: $25.00 year
Renewal: $20.00 year
Lifetime: $200.00

As a member, if you are interested in becoming involved with any of the following:

  • Fundraising

  • Rapid Response

  • Board Member

  • Committee or

  • In Kind Donations

    Please let us know. Thank you for your support

Please let us know. Thank you for your support

MAKE CHECKS PAYABLE TO:
BIKERS UNITED
P. O. BOX 1264
WEST PLAINS, MO 65775

 

BIKERS UNITED
P. O. BOX 1264
WEST PLAINS, MO 65775