APPLICATION FOR MEMBERSHIP
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
(This
application is for new memberships only)
NAME (S)
____________________________________________ ___________________________________________
ADDRESS
___________________________________________________________________________________________
CITY_____________________________________________STATE____________
ZIPCODE+4_____________________
PHONE ( ) _________________________
E-MAIL ADDRESS____________________________________________
OCCUPATION_________________________________________________________________
AGE__________________
ARE YOU AFFILIATED WITH ANY
OTHER MOTORCYCLE ORGANIZATIONS? Yes ______ No______
If yes,
name___________________________________________________________________________________________
DATE:
_____________________________ ARE YOU A REGISTERED VOTER? Yes______ No______
I UNDERSTAND BY SIGNING MY
NAME TO THIS APPLICATION THAT I AM SEEKING MEMBERSHIP INTO A GRASSROOTS
POLITICAL ORGANIZATION FORMED TO PROTECT MOTORCYCLIST’S RIGHTS.
SIGNED:
__________________________________________________________________________________________
RECRUITED BY: ___________________________________________________________________________________
If not recruited, how did you
come to know about CBA? ____________________________________________________
________ $25.00 annual
individual membership ________ $35.00 annual couple membership
Chapter
Affiliation_________________________ (or) you may join as an “At Large”
member_____________
For more information on chapters and the CBA organization, visit www.Randolph-cba.angelfire.com
MEMBERSHIP SERVICES ONLY:
postmarked:_________________ received:_________________ email –
fax – mail sent to State - chapter:___________________
pymt. method: ______________ amt: _____________
expiration date: ______________
date card/packet mailed:
_________________
