SOUTH PENN ENDURO RIDERS MOTORCYCLE CLUB APPLICATION

NAME:______________________________________________________

ADDRESS:___________________________________________________

CITY:________________________________________________________

STATE:_________________________ZIP:_________________________

TELEPHONE NUMBERS

 HOME:_________________________

WORK:____________________

EMERGENCY:______________________

FAX NUMBER:________________________________________________

E-MAIL:______________________________________________________

AMA NUMBER:_______________________________________________

ECEA NUMBER:______________________________________________

DATE OF BIRTH:______________________________________________

CLASS:______________________________________________________

BIKE:________________________________________________________

TYPES OF RIDING:____________________________________________

FAMILY:_____________________________________________________

PERSONAL INTERESTS:_______________________________________

SEND TO SPER

 P.O. BOX 836, CARLISLE, PA. 17013

WITH NEW MEMBERSHIP FEE OF $25.00 & $10.00 RENEWAL

PAYABLE TO SPER