Buffalo Soldiers Membership Application

PLEASE FILL IN ALL INFORMATION

Name (include middle initial):Your chosen biker name:

Street Address:

City/State/Zip Code:

Home #: Cell: Business#:

Age: E-Mail Address:

Emergency Contact Name: Relationship:

Emergency Contact #:

Please give a brief history of yourself (including military service, current employment, and membership

in any other motorcycle clubs).

Are you legally licensed to operate a motorcycle? Yes No

Do you currently own a motorcycle? Yes No If yes, please provide info below:

Type: Model: Year: CCs:

Years of riding experience:

Explain why you are interested in becoming a member of the PM Buffalo Soldiers Motorcycle Club.

I fully understand that the chapter colors purchased by me are the property of the NABSMC and must be

returned to the chapter upon my departure regardless of reason.

Signature: Date: