KNIGHTS OF FIRE MC
APPLICATION FOR MEMBERSHIP

po box 142
Rockaway, NJ  07866

  New Membership   Renewal
NAME

MOTORCYCLE INFORMATION

TELEPHONE                                                      E-Mail MAKE
ADDRESS MODEL
CITY YEAR & COLOR
STATE                                                               ZIP  
DRIVER'S LICENSE NUMBER MAKE
AMA MEMBER?         Q YES        Q  NO MODEL
IF YES AMA NUMBER                                           EXPIRATION DATE YEAR & COLOR
Date Of Birth (optional)  

EMPLOYMENT INFORMATION

PERSONAL REFERENCES

EMPLOYER NAME
BUSINESS TELEPHONE ADDRESS
ADDRESS CITY
CITY, STATE & ZIP TELEPHONE

FIRE DEPARTMENT AFFILIATION

RELATIONSHIP
FIRE DEPT.  
LENGTH OF FIRE DEPT. SERVICE NAME
COMPANY AFFILIATION ADDRESS
MAILING ADDRESS CITY
CITY, STATE & ZIP TELEPHONE
CHIEF OFFICER RELATIONSHIP
DO YOU HAVE A CRIMINAL RECORD?       Q YES         Q NO          IF YES EXPLAIN:

 

FOR CLUB USE ONLY
SPONSORED BY


 

By voluntarily signing this membership application, I hereby release, waive, and covenant not to sue or hold responsible The Knights Of Fire MC Chapter III for any incidents occurring during and to and from any and all club activities. I acknowledge that to some extent all motor vehicles are inherently dangerous. I will take part in all Knights Of Fire MC Chapter III events based upon my own assessment of my riding abilities. I understand that The Knights Of Fire MC Chapter III road trips traverse public highways and that The Knights Of Fire MC Chapter III is not responsible for their conditions nor is The Knights Of Fire MC chapter III responsible for the actions of other individuals using public highways. the Knights Of fire MC Chapter III does not provide any health or liability insurance of any kind. We urge you not to operate your motorcycle without the proper health or liability insurance in effect. I the undersigned expressly acknowledge and assume full responsibility for the risk of bodily injury and/or death, and I, my family, and heirs agree to indemnify and hold harmless The Knights Of Fire MC Chapter III and any and all of its members and officers.
I HAVE READ THE ABOVE RELEASE AND UNDERSTAND IT FULLY

SIGNED                                                                                  DATE                                     

TYPE OF MEMBER

REGULAR
HONORARY
ASSOCIATE
LIFE
FAMILY

DATE RECIEVED                  /           /           

FIRST READING                   /           /           

SECOND READING               /           /           

PROSPECT PATCH               /           /           

FULL COLORS                      /           /