AMCA Everglades Chapter
Membership
Enrollment and Renewal Form
http://evergladeschapter.tripod.com/
Check
One:
New Chapter Member: ________ Renewal: ________
Name: _______________________________________________________
AMCA Member No. ___________________
Address:_______________________________________________________
City:___________________________ Zip Code:_____________________
Phone #1: (
) _________________________
Phone #2: ( )
__________________________
E-mail: ____________________________________________
Facsimile: __________________________________________
Motorcycles Owned/Preferred/Riding Experience/AMCA Background
(optional information to allow us to get to
know one another):
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
By signing below the applicant represents that he/she is a current member of the national AMCA,
and agrees to abide by the Bylaws and rules and regulations of the Everglades Chapter.
$15 annual dues enclosed. Please make check payable to AMCA Everglades Chapter.
Return
this page with $15 dues to:
David Porter
Everglades Chapter Treasurer
13250 SW 224 St, Miami, Florida, 33170
Signature: _______________________________________________
Date: ___________________