Mbr-Appln-Form

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. *

I acknowledge that helmets are mandatory for all drivers and passengers participating in club sanctioned rides *

Driver Driver & Passenger

Applicable to *

I have read, understand, and agree to fully comply with the By-Laws *

Driver Driver & Passenger

Passenger/Spouse (if applicable) *

First

Last

Winter/Full Time Address *

Line 1

Line 2

City

State

Zip Code

Country

Summer Address (if applicable) *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Mobile Phone Number *

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

Passenger/Spouse Photo *

Max file size: 20MB

Driver Birthday - Day *

Driver Birthday - Month *

Driver Birthday - Year *

Passenger/Spouse Birthday - Day *

Passenger/Spouse Birthday - Month *

Passenger/Spouse Birthday - Year *

First year dues of $20 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? *

If Other, indicate below *

Please don't not print this application, but submit it electronically by using the Submit Application button below.

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New Member Application

Power Riders Motorcycle Club Member Application