New Member ____             Full Membership _____

 One application per person.          Renewal _____                   Associate Membership _____

Name __________________________________________E-Mail ___________________

Street Address ___________________________________________________________

City__________________________State_________________________Zip____________

Telephone - Home __________________Work or Cell ____________________________

Birthdate __________________________Anniversary_____________________________

Occupation & Place of Employment ___________________________________________

Motorcycles You Presently Owm (Make, Model, Year)______________________________

_______________________________________________________________________

No. of Miles Ridden Last Year _____________No. Years Riding ___________________

Are you an AMA Member? ________________AMA No. ___________________________

Have you taken an MSF Course? _________________________

Your favorite ride _________________________________________________________

PLEASE READ AND SIGN THIS WAIVER

I understand that motorcycle riding can be dangerous and agree that neither Mid-Michigan Riders nor any of it's Officers or Members will be held responsible for accident, injury or loss, in connection with Club activities including travel periods to and from those activities.  I also agree and understand that there will be no drinking of alcoholic beverages during club activities.

Signature _____________________________________Date ______________________

Dues are $20 per year Full Membership $5 Associate Membership.    Complete form and mail with payment to:

Mid Michigan Riders, P. O. Box 172, Eagle, MI 48822

MMR 2010 Annual Waiver

Please  Print this waiver and sign  it with your application