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MEMBER FORM |
| Members: We'd like to keep in touch with you. If your information has changed, please email the new information to Mary Kay Wilson, Membership Enhancement. Thank you! |
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| Guests: To be included in Chapter communications, please complete the information below and deliver to Mary Kay Wilson or the Chapter Director, Tom Lorenz. |
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| Rider Name: |
| Co-Rider Name: |
| Motorcycle: |
Years Riding: |
| Address: |
| City: |
Zip: |
| Phone - Rider: |
Cell: |
| Phone - Co-Rider: |
Cell: |
| Email - Rider: |
| Email - Co-Rider: |
| Birthdays: Rider: |
Co-Rider: |
Anniversary: |
| GWRRA# Rider |
Co-Rider: |
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