Ft Leavenworth Buffalo Soldiers Motorcycle Club Application Form
Please complete all areas
Personal Information
Name
*
First Name
Last Name
Cell Phone Number
*
-
Area Code
Phone Number
Home/Work Phone
-
Area Code
Phone Number
Email
*
example@example.com
Residence Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Information
Name
First Name
Last Name
Emergency Contact phone number
-
Area Code
Phone Number
Emergency Contact Email address
example@example.com
Relationship to Emergency Contact
Relationship
Basic Requirements
Are you legally licensed to operate a motorcycle?
Are you 18 years of age or older?
Do you currently own a motorcycle?
Have you been a member of another MC?
Make, Model and Year of your Motorcycle:
Explain your riding experience, include the number of years.
Brief history of yourself: (include military service, current employment, and any other motorcycle clubs).
Explain why you are interested in becoming a member of the Ft. Leavenworth Buffalo Soldiers MC.
Availability
Are you willing and able to participate in community service projects?
Are you willing and able to participate in the occasional out of state rides?
References
Who referred you?
Terms and Conditions
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
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Submit
Submit
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