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New Member Application
Power Riders Motorcycle Club Member Application
*
Indicates required field
Name (Driver)
*
First
Last
I acknowledge that motorcycle riding is an activity that has an inherent risk of damage or injury. I hereby release the PRMC officers and leaders from any liability for such injury or damage resulting from my participation in any PRMC motorcycle riding activity.
*
Choose One
Yes
No
I acknowledge that helmets are mandatory for all drivers and passengers participating in club sanctioned rides
*
Driver
Driver & Passenger
Applicable to
*
Choose One
Driver Only
Driver & Passenger
If submitting this application for yourself as a driver AND your spouse who may at any time ride with you on group rides, you MUST both agree to the liability waiver.
I have read, understand, and agree to fully comply with the By-Laws
*
Driver
Driver & Passenger
Passenger/Spouse (if applicable)
*
First
Last
For non-drivers joining the club only. If you are applying as a couple and both parties drive, please submit two applications.
Winter/Full Time Address
*
Line 1
Line 2
City
State
Zip Code
Country
Summer Address (if applicable)
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Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
Mobile Phone Number
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Other Phone Number
*
Email
*
Emergency Contact Name
*
First
Last
Emergency Contact Phone Number
*
Emergency Contact Email
*
Motorcycle Photo
*
Max file size: 20MB
Driver Photo
*
Max file size: 20MB
Please attach a close up (head & shoulders) current photo (without helmet).
Passenger/Spouse Photo
*
Max file size: 20MB
Driver Birthday - Day
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Choose One
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Driver Birthday - Month
*
Choose One
January
February
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December
Driver Birthday - Year
*
Choose One
1937
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Passenger/Spouse Birthday - Day
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Choose One
1
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Passenger/Spouse Birthday - Month
*
Choose One
January
February
March
April
May
June
July
August
September
October
November
December
Complete only if applying as a couple
Passenger/Spouse Birthday - Year
*
Choose One
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
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1950
1951
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1953
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1970
First year dues of $18 per person are payable by check or cash to the Membership Director. Please make checks payable to
Power Riders Motorcycle Club
.
All items indicated with an
*
must be completed before submitting application.
How did you hear about us?
*
Choose One
Referral from existing club member
Internet search
Saw club members on a ride or at a meet-up
Referral from another club
Motorcycle Dealer or Shop
Advertisement
Other
If Other, indicate below
*
Please don't not print this application, but submit it electronically by using the
Submit Application
button below.
Submit Application