Application for Membership/Renewal

 BUCKEYE BEEMERS MOTORCYCLE CLUB

Application for Membership/ Renewal
(Revised 11/03/21)

NAME: ____________________________________________________________________
ASSOCIATE MEMBER NAME _____________________________________________
STREET ADDRESS:_____________________________________________________
CITY:__________________________________________________________________
STATE/ZIP:____________________________________________________________
HOME PHONE: __________________________ WORK PHONE________________
E-MAIL ADDRESS ______________________________________________________
+++++++++++++++++ BEEMERS M/C Owned:____________________________________________________________
AMA#_________________ MOA# ____________________ RA#_________________
OTHER CLUBS ________________________________________________________
INTERESTS (please circle): Rallies / Touring / Camping / Sidecars / Racing / Vintage / Dinner Rides / Breakfast Rides / Other______________________________
++++++++++++++++++

Dues: New Member $35.00, Renewal $35.00, New Associate(same address as member) $5.00, Renewal Associate $5.00
I hereby release the BUCKEYE BEEMERS M/C CLUB from all liabilities and/or claims that may arise or that I may otherwise receive as a result of my membership or participation in any BUCKEYE BEEMER sponsored activities.

__________________________________ _____________________________
Applicant Signature & Date Associate Signature & Date
Make checks payable to BUCKEYE BEEMERS and mail to BUCKEYE BEEMERS, 5405 Infinity Court Grove City Ohio 43123
++++++++++++++++++