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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: Bob Anderson Everglades Chapter Treasurer 1002 Glenham Drive NE / Palm Bay, FL 32905 Signature: _______________________________________________ Date: ___________________ |