Year 2010
Application for membership in
RHODE ISLAND CHAPTER
RETREADS MOTORCYCLE CLUB INTERNATIONAL, INC.
AMA CHARTER 3233
Date: Month._____/Day._____/Year._____
Please check one: ___New
___Renewal
Please Complete the following in full (print or type):
Rider: __________________________________ Co-Rider: ____________________________
Address: __________________________ City: ____________________________
State: ___ Zip: ______ Home Phone: (___) ___________ Cell Phone: (___) _______________
May we place your Home Phone No. on our Members Phone List? ___YES ___NO
E-Mail Address: ____________________________________
Rider’s Birthday: ____/____/____ Co-Rider’s Birthday: ____/____/____
Wedding Anniversary: ___/___/___
AMA Number (if a member): __________Expiration Date: ____/____/____
Occupation: __________________________________________________________
Hobbies: _____________________________________________________________
Motorcycle: 1st Bike – Year:____ Make:________________ Model_____________
2nd Bike – Year:____ Make:________________ Model_____________
From Whom or Where Did You Hear About Us?:_____________________________
Yearly Membership/Newsletter Donation:
Postal Mail - $15.00 Single ___ $20.00 Couple ___
E-Mail - $10.00 Single ___ $15.00 Couple ___
Make Check Payable To: “RI Retreads Motorcycle Club”
Return App.To: Ron & Robin Cardin, 97 Spruce Rd., Norwood, MA 02062
DUE TO THE INCREASED COSTS IN PRINTING AND MAILING WE WOULD APPRECIATE AN ADDITIONAL $2.00 DONATION FROM THOSE THAT CAN, WHO RECEIVE THEIR NEWSLETTERS VIA POST MAIL
IMPORTANT: This must be signed by all club members.
I understand that neither the Retreads Motorcycle Club International, Inc., or it’s RI Chapter, can
assume responsibility for any aspect of my safety. I understand that my participation in any Retread
activity is strictly voluntary and further, I release and hold harmless the Retreads or any Retread
member from any loss to my person or property.
Rider Signature: _________________________________________ Date: ________
Co-Rider Signature: ______________________________________ Date: ________
THE FOLLOWING TO BE COMPLETED BY RI STATE REP. ONLY
DO NOT WRITE BELOW THIS LINE
Retread Membership Card Number(s): Rider________ Co-Rider_______
CHECK #_______
