Long Riders MC NO.CAL

       Until further notice ** WEST COAST ONLY **

 Date _______              AKA's _____________                   Road Name_________________

 

Your Email______________________________

First Name______________

Last Name_______________

Address_______________________

City_____________

State_____________                  Zip Code__________                   Phone Number_____________

Occupation__________________

 

Major Adventures Accomplished  ( briefly )____________________________________________

_________________________________________________________________________

 

Prior Arrests And Convictions______________________________________________________

_____________________________________________________________________________

 

Medications Disclosure   ( mandatory,but for administration purposes only )____________________

_____________________________________________________________________________

 

Other Club Afffiliations  ( current and past )___________________________________________

____________________________________________________________________________

 

Why Would You Like To Become A Longrider_______________________________________

___________________________________________________________________________

 

I ______________________________________avow that the information in my application is true and correct.

I am aware that embellishment of my credentials may subject this application to denial. I also avow, should my application  be accepted,that I understand and will abide by the Long Rider Creed and show respect for the Long Rider Patch at all times.

                                                                     Application Must Be Completely Filled Out

PRINT APPLICATION AND MAIL TO:

JS-Gambler

30 B Greevview Circle

Chico Ca. 95928