MEMBERSHIP APPLICATION

FIRE AND IRON MOTORCYCLE CLUB, STATION 144

(please print)

 

DATE:__________________

NAME:___________________________________________________________

ADDRESS:________________________________________________________
HOME PHONE:____________________________
CELL PHONE:_____________________________

E-MAIL:__________________________________

EMERGENCY CONTACT NAME & NUMBER:__________________________                                              

                                                                                __________________________
FIRE DEPT:_________________________________active___ retired___

EMPLOYER: (sponsored applicant only)_________________________________
IF SPONSORED, SPONSORES NAME:_________________________________

MAKE, MODEL & REGISTRATION NUMBER OF BIKE:_________________
                                                                  _________________________________

 

I, the undersigned, understand the rules and responsibilities of membership in Fire and Iron Motorcycle Club and pledge loyalty to the club.

 

PRINT NAME:______________________________________________________

 

SIGN NAME:_________________________________________DATE:_________

 

SPONSORS NAME:____________________________________DATE:________

 

PRESIDENTS SIGNATURE:_____________________________DATE:________

 

Request a copy of Fire and Iron Rules at secgeneral@fireandironstation144.com

Please mail completed form with $85.00, ( $25.00 Annual dues, $60.00 initiation fee) to:

Fire and Iron Station 144