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:  ___________________