PACESETTERS MOTORCYCLE CLUB® MEMBERSHIP APPLICATION

Name:

LAST

FIRST

MIDDLE

Address:

Number

Street

City

State

Zip 

Phone Number:

Area Code Please

Date Of Birth:

Name of Employer:

Address:

City,State & Zip:

Phone Number:

Referred By:

PERSON TO BE NOTIFIED IN CASE OF EMERGENCY

Name:

Relationship:

Address:

City, State & Zip:

Phone Number:

This club is an equal opportunity organization: We adhere to a policy of making decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability.  We assure you that your opportunity for membership with this organization depends solely on your qualifications.

Thank you for completing this application and for your interest in the Pacesetters Motorcycle Club®.

Date:

Years of Experience Riding Motorcycles:

Type Of Bike You Ride:

Email Address:

Position

Have you ever been a member of any other clubs. (If Yes how long & Name of Club)

All Applicants are subject to background checks.

Hobbies:

Liability Statement: By submitting this application online, I and anyone who may act as my representative agree to release Pacesetters Motorcycle Club from any and all actions, suits or nature for personal injury, death, property damage, medical and hospital expenses, or loss of wages resulting from my participation during any activities, and voluntarily agree to assume all risks associated.

I AGREE

I AGREE