Red Knights International Firefighters Motorcycle Club, Inc. Pennsylvania Chapter # 17 Pottstown , Pa. Membership Application

(PLEASE PRINT)

Name (Last, First) _______________________________________________________________

Address ________________________________________________________________________

City ____________________ State _______ Zip Code __________

Phone (Home) ____________________ (Cell) ________________ (Nextel ID) _______________

E-Mail Address __________________________________________________________________

Age __________ D.O.B. _____/_____/______ (mm/dd/yyyy)

Membership Type ____ Active____ Social____ Associate____ Honorary

Fire Company Affiliation _________________________________________________________

(Required for Active Membership)

Chief/Supervisor____________________________________ Phone ______________________

Fire Dept. Status _____ Active_____ Social_____ Retired

_____Paid _____Volunteer _____ Military _____ Industry/Brigade

I, the undersigned, do hereby apply for membership in the Red Knights International Motorcycle Club, Pottstown , Pennsylvania Chapter # 17. I agree to abide by the Red Knights International Motorcycle Club Constitution and By-Laws and the rules and regulations governing this Local Chapter.

Liability Waiver: I also agree to wave and not hold the club, (Local or International), any Officer or Member responsible for any injury or equipment damage while at, to or from a meeting or motorcycle ride or event.

Signature of Applicant: __________________________________ Date_____/_____/_____

First years Dues of $20.00 for Active or Associate Membership OR $15.00 for Social Membership needs to be submitted along with this application.

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This section completed by the Executive Board:

Application Approved: __________________ Rejected: __________________

Signature: _________________________________ Date: __________________

“Loyal To Our Duty”