Membership Application
STATE:                                      ZIP:  
Home Phone:                                            Business Phone:                                 Cell Phone:
Emergency Contact Name, Relationship, and Phone Number:
Please give a brief history of yourself: (include military service, current employment, other MC clubs:
No
No
MAKE :                                                 MODEL:                                YEAR :                                  CCs:
Explain Why you are interested in becoming a member of the Louisiana Buffalo Soldiers Motorcycle
Club:
NAME (Last, First MI)
AGE:
ENTER YOUR BIKER NAME(AKA):
EMAIL ADDRESS:
STREET ADDRESS:
CITY:
Yes
Are you legally licensed to operate a motorcycle:
Yes
Do you currently own a motorcycle:
Have you taken the MC Safety Course?
Number of Years Riding Experience:
Check Box and Type Your Name:
Date: