APPLICATION FOR RENEWAL
CONCERNED BIKERS ASSOCIATION/ABATE OF RANDOLPH COUNTY
NC, INC.
PLEASE PRINT AND MAIL TO:
CBA/ABATE of RANDOLPH COUNTY NC
MEMBERSHIP SERVICES
PO BOX 817
Asheboro, NC 27204
NAME (S)
____________________________________________________________________________
ADDRESS:___________________________________________________________________________
CITY:___________________________________STATE:________ZIPCODE+4
____________________
PHONE ( )_________________ E-MAIL
ADDRESS _____________________________________
OCCUPATION:____________________________________________________
AGE: ______________
OTHER MOTORCYCLE AFFILIATIONS
___________________________________________________
ARE YOU A REGISTERED VOTER?
Yes_______ No _________
Your continuing membership is valued.
As a member of CBA, your ideas, suggestions and comments are important to our
organization.
Your comments will be used anonymously to
implement and improve current and future programs within the organization.
________________________________________________________________________________________________
I UNDERSTAND BY SIGNING MY NAME TO
THIS APPLICATION THAT I AM RENEWING MYMEMBERSHIP INA GRASSROOTS POLITICAL
ORGANIZATION FORMED TO PROTECT
MOTORCYCLIST’S RIGHTS.
SIGNED:__________________________________________________________DATE:_________________
Annual Renewal Dues:
_______ Individual $25.00 _______ Couple $35.00
Membership
renewals must be returned with payment as soon as possible to prevent a lapse
in membership. Renewal applications and dues MEMBERSHIP SERVICES ONLY
:postmarked:______________received:________________by
email –fax –mail sent to State
–chapter_________________Pymt.method______________amt______________expiration
date:_______________renewal card
mailed:________________RENEWAL DATE _______________CHAPTER: ______________________“AT LARGE”MEMBER
MAIL
APPLICATION WITH PAYMENT TO:CBA/ABATE OF NCMEMBERSHIP SERVICES P.O. Box 817 Asheboro, NC 27204
may be submitted to your local chapter or mailed to this Membership Services address.