New Member Application

FMC New Member Application

NAME______

HOME ADDRESS______

CITY, STATE, ZIP______

HOME PHONE #______

WORK PHONE #______

MOBILE PHONE #______E-MAIL ADDRESS

Optional: Motorcycle: Years riding experience: Safety Courses passed:

Riding Level: ____BEGINNER ____INTERMEDIATE ____ADVANCED

Member Status (for FERA-IRS Purposes only) Please Check one.... I am a: ___Ford Employee, ___ Contract Employee,___A-Plan Eligible, _____Other

Ford Employees Only:

InterCo Address______Email ID______

Office Use Only: Dues Paid______Patch Picked Up?______

Please send completed form, together with a check for $20 annual dues, payable to Ford Motorcycle Club, via snail-mail to: Ford Motorcycle Club c/o Andrew Swift, 18400 Ryanwood Dr., Riverview, MI. 48193. Annual dues are $20, payable to "Ford Motorcycle Club". Please do not send cash. Rev. 4/11/2017