Application for Membership

PLEASE PRINT LEGIBLY

NAME ____________________________________________________________

ADDRESS _________________________________________ Apt.#___________

CITY _____________________________________ STATE ______ ZIP _________

HOME PHONE ________________________ CELL PHONE __________________

EMAIL _____________________________________________________________

__ Address Change

EMERGENCY INFORMATION:

CONTACT _________________________________ PHONE _________________

DATE OF BIRTH ___________________________ GENDER __ Male __ Female

I am interested in volunteering for:

__Day Rides

__Three Flags Classic

__Board Positions

__Other ________________

	One Year	Two Year
New Member	__$25	__$45
Renewal	__ $25	__ $45

Renewing Life Member

__ Free

Existing Membership # _____________________________________ Expires _______

Club Name ___________________________________________________ __ Outrider

In making this application for membership, I hereby agree to comply with the rules governing the Southern California Motorcycling Association while holding membership. SIGNATURE _____________________________________________ Date __________________

For Office Use

S.C.M.A #______________ Expires________________

Revised 01/01/12

If you have any questions, please send an email to sallyjbishop65@gmail.com or call Sally Bishop 714.693.7801

Mail w/ check to: SCMA PO Box 487 Norwalk, CA 90651-0487

Please allow sufficient time before the start of the 3 Flags Classic and/or your USA 4 Corners Tour to allow processing and return mail.

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P.O.Box 487 | Norwalk | CA 90651-0487