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Name _________________________________________ Spouse ________________
Address ___________________________________ City _____________________
State ___ Zip ______ Home phone _________________ Cell _______________
AMA # _________ Exp. ______ E-mail ___________________________________
Motorcycle(s) ________________________________________________________
Special Interests ____________________________________________________
How often do you ride ________________________________________________
Reasons for joining BBTR _____________________________________________
______________________________________________________________________
2006 Annual Club Dues Options:
Individual (includes one club jersey) $25.00 __________
Family (includes one club jersey per family) $45.00 __________
Club Jerseys @ $20.00 each ________________ S, M, L, XL, XXL (circle)
Club Jackets @ $85.00 each ________________ S, M, L, XL, XXL (circle)
Make check or money order payable to BBTR. Check/M.O. # __________
Please mail dues and application to our club treasurer:
Marc Parnes, 6691 Alamitos Circle, Huntington Beach, CA 92648
As a BBTR Club Member, I agree to abide by and support the club by-laws, as adopted by the club. I also agree to hold the club and its officers harmless in the event that I am injured while participating in any club activities.
Signature _______________________________________ Date ____________
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