Membership

Application for Membership

RETREAD MOTORCYCLE CLUB INTERNATIONAL INC.

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AMA CHARTER 3233

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NEW MEMBERSHIP

RENEWAL MEMBERSHIP

XL+

DATE: _____________________

RETREADS GROUP NAME:______________________________________________________ GROUP DIRECTOR GROUP ASST. DIRECTOR AREA REP ARE YOU?: Please type or print: **Name, **address, and **date of birth must be filled in, before a membership card is issued. You or your spouse must be over the age of 40 years to be a full member. MEMBERSHIPS ARE VALID FROM JANUARY 1ST THROUGH DECEMBER 31ST.

**NAME: ________________________________ **SPOUSE: _______________________________ **ADDRESS: _____________________________________ CITY: ___________________________ STATE: _______________ ZIP: _______________ PHONE: (________)______________________ SUMMER ADDRESS: ________________________________________________________________ EMAIL ADDRESS: ___________________________________________________________________

YES, SEND ME THE NEWSLETTER USING EMAIL **APPLICANT’S BIRTHDATE: __________________ SPOUSE’S BIRTHDATE: ________________ MAKE OF MOTORCYCLE(S): YOU ______________________ SPOUSE _____________________ Other motorcycle affiliations (civic organizations) [I.e.] AMA, GWRRA, HOG, CMA, ABATE, IBMC, Eagles, Moose, VFW, etc.: DONATION: $________ $20.00 (PER COUPLE) PER YEAR $________ $15.00 (SINGLE) PER YEAR ***MAKE CHECKS PAYABLE TO: SUNSHINE REGION RETREADS Please return application to: Florida State Directors Jack and Carol Schardine 1434 Golden Park Ct. email: [email protected] Tallahassee, FL 32303 Important: this Must Be Signed by ALL Applicants: I understand that the RETREADS cannot assume responsibility for any aspect of my safety. I understand further, any participation in any RETREAD activity is strictly voluntary and further, I release and hold harmless the RETREADS and/or RETREAD member from any loss to my person or property. Signature(s): ________________________________ (Rider)

__________________________________ (Co- Rider)