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GR Patch MEMBER
INFORMATION INTAKE
FULL LEGAL NAME
*
PHONE NUMBER
*
PERSONAL EMAIL
*
HOME ADDRESS
*
BIRTHDAY
*
Month
Month
Day
Year
MOTORCYCLE TYPE
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EMPLOYER
*
HEALTH, MEDICAL & ALLERGY NOTES
*
EMERGENCY CONTACT #1 NAME & RELATION
*
EMERGENCY CONTACT #1 PHONE NUMBER
*
EMERGENCY CONTACT #2 NAME & RELATION
EMERGENCY CONTACT #2 PHONE NUMBER
PROOF OF VALID DRIVER'S LICENSE (CLASS M)
*
Upload File
PROOF OF VALID FULL COVERAGE MOTORCYCLE INSURANCE
*
Upload File
I GIVE CONSENT TO GRAVE ROBBERS MC TO PERFORM A BACKGROUND CHECK.
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I agree
I do not agree
I UNDERSTAND THAT ALL PATCHES ARE THE SOLE PROPERTY OF GRAVE ROBBERS MC AND MAY BE MANAGED AS SUCH. IN THE CASE OF REMOVAL OR RESIGNATION (VOLUNTARY OR INVOLUNTARY), I AGREE TO RETURN ALL CLUB PROPERTY.
*
I agree
I do not agree
I UNDERSTAND THAT ALL GOVERNING DOCUMENTS ARE THE INTELLECTUAL PROPERTY OF GRAVE ROBBERS MC. NO COPIES OR DUPLICATES MAY BE MADE. NO ONE OUTSIDE OF THIS CLUB SHOULD BE GIVEN ACCESS TO THESE DOCUMENTS.
*
I agree
I do not agree
TODAY'S DATE
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SIGNATURE
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