Ghost Ryderz

Official Membership Application Print out and mail in form or submit on line now.	Member and/or Sponsor Fill out please: New Member Previous Member Renewal
*Name:
*D.O.B.
*Address :
*City:
*State :
*Zip :
*Phone#:
Cell#:
Beeper#:
*Email:
I presently own a motorcycle:	Yes No
If Yes:	Plate#:
State:
Current operator's license:	Yes No
If Yes, operator's license #:
Is license motorcycle rated:	Yes No
If No, Permit issue date
Expiration:
Type of motorcycle presently owned
Make:
Model:
Year:
How long have you've been riding?
Have you ever had a motorcycle accident?	Yes No
If Yes: How many times?
Emergency notification:
Name:
Address :
City:
State :
Zip :
Phone:

*All information provided above is explicitly for the use of membership application and will not be sold or distribute to any third parties at any time.

Ghost Ryderz
Extreme Motorcycle Club
P. O. Box 319
Ronkonkoma, New York 11779
WWW. GHOSTRYDERZ.COM
516-885-7843

Š2004

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