APPLICATION FOR MEMBERSHIP
CONCERNED BIKERS ASSOCIATION/ABATE OF NC, INC.
PLEASE PRINT OF TYPE YOUR INFORMATION (This application is
for new memberships only)
NAME(S)_________________________ _______________________________
ADDRESS________________________________________________________
CITY_____________________________STATE____ZIPCODE+4____________
PHONE( )__________________________________________AGE________
MAKE/SIZE OF MOTORCYCLE______________MILES PER YEAR________
ARE YOU AFFILIATED WITH ANY OTHER MOTORCYCLE ORGANIZATIONS?
YES_____ NO_______
If yes, name_______________________________________________________
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____________________________________________________
_______ $25.00 annual individual membership
_______ $35.00 annual couple membership
Chapter Affiliation___________________(or) you may join as an "At Large" member_____________
Mail your completed application with payment to:
CBA/ABATE OF NC
MEMBERSHIP SERVICES
PO BOX 1189
FUQUAY-VARINA, NC 27526-1189
FOR NEW COLUMBUS COUNTY MEMBERS ONLY: TURN IN DIRECTLY TO CHAPTER OR MAIL TO: COLUMBUS COUNTY
CBA, PO BOX 669, CHADBOURN, NC 28431
