Membership Application
The American Legion Riders Hampstead Post 200 Hampstead, MD
Membership Information: (complete this section in its entirety)
Name
*
First Name
Last Name
Preferred Name/Nickname/Rider Name
Home Address
*
Apt
City
*
State
*
Zip
*
Home Phone
*
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Birth Date
*
/
Month
/
Day
Year
Date
Email Address
*
example@example.com
Are you an... (Choose one)
*
ALR Member
ALR Support Member
Emergency Contact Info
Emergency Contact Name
*
Emergency Contact Number
*
Please enter a valid phone number.
Bike Information (ALR Member)
Make
*
Model
*
Displacement
*
Year
*
I, the undersigned, certify that the motorcycle listed above is legally registered in accordance with state, city and/or local licensing and registration requirements. I further certify that I carry property and liability insurance for myself, my passengers and the motorcycle which meets at least the minimum state, city and/or local insurance requirements. I also certify that I carry a valid driver's license. I further certify that I have the legal right to utilize the listed motorcycle. I accept full responsibility for my safety and conduct and the safety and conduct of any who may be participating as my guest or passenger in this organization. I realize that these are requirements for my participation in this organization.
*
I Agree
I Dont Agree
Signed
*
Date Signed
*
/
Month
/
Day
Year
Date
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