Club Rhino Application For Membership

APPLICATION FOR MEMBERSHIP Surname:___________________First Name: ____________________Middle Name: ________________ Desired Codename: __________________ email address: _____________________________________ Home Address: __________________________________ _______________________________________________ Office Address: ________________________________________________________________________ _____________________________________________________________________________________ Cell Phone: _______________________ _____________________________ _____________________ Notify in case of Emergency: ______________________________ relationship: ____________________ T.I.N. ___________________ Birthdate: (d/m/y) _______________________ Age: ________________ Civil Status: __________ Blood Type: ______ID No. ____________, date/place Issued_______________ Other Affiliations: ______________________________________________________________________ _____________________________________________________________________________________ Referred by: ________________________________________________________(Club Member) Rate Yourself as a Rider: ____________ (Nicky Hayden: 10, lowest rate is 1) Then we rate you at the track. ______ BIKE DATA: Manufacturer

Make

Year Model

Displacement (cc)

I hereby certify that the above information is true and correct as of my knowledge and based on authentic documents. 1x1 pic

________________________________________ Signature n.b. This application must be accompanied by P2,000.00 for new applicants.