Leather and Lace Motorcycle Club Application

Membership accepted on:	_____ On Computer _____ In Newsletter	Print this page and mail to the address listed
	Membership Application
Type of Membership applying for:	Social [ ] Associate [ ]	Support [ ] Full [ ]
Full Name: __________________	Nickname: _______________	Email: __________
Address: ___________________	City: _____________________	State:__________ Zip: __________
Phone: _____________________	Birthday: _________________	Married ( ) Single ( ) Divorced ( )
Husband Name: _____________	His Birthday: ______________	Do you have a valid cycle license? ____
How long have you been riding your own motorcycle ? _____________	What make, model, & size cycle do you own? __________________	D.L.# ___________________
Are you a member of any other motorcycle organizations? _________	Name of Organization: ___________	Years as member: __________
Do you presently hold an office with this organization? Yes { } No { }	Office held: ___________________
Is your Husband/Ol' Man a member of any other organization or club? ______	Name of Organization: ___________	Years as member: __________
Children/Grandchildren Name(s) ____________________________ ____________________________ ____________________________	Gender / AGE: ____________________________ ____________________________ ____________________________	Date of Birth: ____________________________ ____________________________ ____________________________
Would they be interested in becoming	Future Lace; Teen Lace; or Little Brothers? Yes { } No { }

What interested you in becoming a member of Leather & Lace?

Do you Know of any other women riders? Yes { } No { }

Would they be interested in receiving membership information. Yes { } No { }

Name: _________________ Phone: _______________ Email: __________ Address: ______________________

Are you interested in starting a chapter in your area? Yes { } No { } --- What area are you thinking of? ___________

The following information will be held in the strictest of confidence and will be used only through the result of an EXTREME EMERGENCY

In case of an emergency, who would we notify? ____________________ Relationship: ____________________

Phone: _____________Address: _______________ City: _______________ State: _______ Zip: _________

Your Blood Type: _______ Do you have any allergies or any Medical Information we need to be aware of?

If so, please list.: ___________________________________________________________________________

Do we have your permission to print your name and address in the Leather & Lace membership directory? ________

Do we have your permission to print your telephone number? Yes { } No { }

The membership directory is available to members only. We cannot be held responsible should it fall into the wrong hands after delivery.

Your signature: _________________________________ Date: __________________

Chapter Members Please check with your Chapter Treasurer for correct payment procedure.

Please tell us a little about yourself . . .

* What kind of job are you presently employed at, and how do you like it?

* What kind of hobbies and activities interest you besides motorcycles?

*What crafts/skills do you have that you'd be willing to volunteer to the Association to better our image and promote our goals?

Social Membership $55.00 per year
Support Membership $25.00 per year
Nomad Membership dues are $50.00 per year
Forward all dues to: Leather & Lace MC	c/o National Treasury, PO Box 729, Edgewater, FL 32132