APPLICATION TO JOIN

MOTORCYCLE RIDERS GROUP

All Motorcycle Riders Group Members must be members in good standing of the IAC of Sebastian.  You must have a valid license in order to ride with this Group.

Please Print All Information Except Signature:

Name:  _________________________________________________

Address:  ______________________________________________

____________________________, Florida  329___

Phone Number:  (_____) ______-___________

E-Mail Address:  ____________________________________________

I have my Motorcycle Endorsement on my license:  [__] YES     [__] NO

If not, are you taking the Motorcycle Safety Course:  _______________

I have my own motorcycle:  [__] YES     [__] NO

If not, will you ride with someone else:  ___________________

I have read the Liability Release (on a seperate application) and agree by signing on the appropriate line.

__________________________________________________

                          SignatureDate

Italian-American Club of Sebastian, Florida

Motorcycle Riders Group

861 SR 512-Sebastian, FL  32958

Peter T. Puzzo-Director

Suzanne Richards-Secretary

Beverly Puzzo-Treasurer