Member's Name ______________________________________________Nickname_____________________
Associate's Name _______________________________________________Nickname____________________
________________________________________________________________ ZIP _______________
Home Phone (_____)______________ Work Phone(s) _(_____)________________/_(_____)_______________
E-Mail address __________________________________________________________________
Member/Associate Occupations _______________________________/______________________________
BMWMOA Member? Yes _____No_____ MOA #'s____________/____________
BMWRA Member? Yes _____No_____ RA #'s____________/____________
BMW Model(s) _____________________________ Year(s) ___________________________Sidecar? ________
Other Clubs, Hobbies, Interests: _________________________________________________________________ ___________________________________________________________________________________________
In case of EMERGENCY, notify: ________________________________________________________________
Address: ________________________________________________________________ Phone: (_____)_______________
Release to BMWMCHR: I, the undersigned, hereby agree to abide by the club by-laws, and do relieve the BMWMCHR from any liability for personal property damage, theft, bodily injury, or motor vehicle accident that might occur as the result of my participation in club events or my membership in the club.
Associate Member ___________________________________________Date_____________
Dues: $20.00 per year. After July 1, $10 for the remainder of that calendar year. $5.00 per year for Associate Membership. $10.00 per year for Corresponding Membership if you live out of townť, but still wish to be a member Mail/Deliver.
Application & Dues (check payable to "BMWMCHR") to:Rusty Barton 3205 Twinflower Lane Virginia Beach, VA 23453 757-427-0315
Club Information The BMW Motorcycle Club of Hampton Roads is a close-knit group of BMW riders and their families from throughout the Tidewater area. Our member's backgrounds are as diverse as their riding styles, from peg-draggers to sedate touring bikes. We welcome all riding styles and all BMW models vintage airheads through the latest in oilheads and K-tech.