Alhambra Easy Riders Motorcycle Unit

                                                             (Sample ) 

                      ALHAMBRA EASY RIDERS - Membership   Petition

                                                           1000 Alhambra Drive 

                                                                     Chattanooga, Tennessee 37421 

                                                                             Phone (423) 892-0223                                    

                                      _______________________

                                                    Date 

Please complete this petition and give to any member of the Alhambra Easy Riders Unit.  This form will be given to the Unit Secretary and will be presented to the membership of the Alhambra Easy Riders Unit.  This form will be used to record membership data and will only be used for Alhambra Easy Riders membership purposes and will not be disseminated to any other organization.

Please PRINT all information

FIRST NAME ________________________Nick Name ________________

                                                                       (If applicable)

MIDDLE NAME ___________________________________

LAST NAME _____________________________________

STREET ADDRESS OR P.O. BOX # __________________________________________

CITY   _____________________STATE  _____ZIP CODE  _____________________

HOME  PHONE # (_____)  _____________WORK  PHONE  # (_____) ____________

                                                                                      (If applicable)

CELL PHONE #   (_____)  ______________

                             (If applicable)

EMAIL ADDRESS

__________________________________@___________________________________

                                                   (Please Print)

BIRTHDAY _______________  ___________   _______________

                   Month                   Day                   Year

MASONIC LODGE NAME  __________________________  NUMBER  ____________

FIRST NAME OF SPOUSE _______________________________ (If applicable)

SPOUSE BIRTHDAY  ____________________         ___________

                                      Month                             Day

I hereby apply for membership in the Alhambra Easy Riders. 

If elected for membership, I will abide by the by-laws governing said unit. 

________________________________________________________    

Signature of Applicant

Referred by Alhambra Easy Riders Member:   __________________________________

Action by Membership:  Date    _____________  APPROVED           DISAPPROVED 

                                                                                    (Circle One)