AMA Charter 3233
New______ Renewal ______ Date____________________________________________I understand that the Retreads® cannot assume responsibility for any aspect of my safety. I understand that my participation in any Retreads® activity is strictly voluntary and further, I release and hold harmless the Retreads® or any Retreads® member from any loss to my person or property.Name _____________________________Spouse_________________________________
Address__________________________________________________________________
City_______________________________ State________________ Zip Code__________
Telephone__________________________ Email__________________________________
Your Birthdate______________________ Spouse Birthdate__________________________
AMA Number (if member)______________ Expiration Date__________________________
Other motorcycling affiliations__________________________________________________
Occupation________________________ Hobbies________________________________
Make(s) of Motorcycle(s)_____________________________________________________
Donation __________________________ (Minimum $15 single, $20 w/spouse suggested)
Referred by_________________________________________________________________
Signature____________________________Spouse________________________________ Date___________
Mail completed application to:
PO Box 1915
Belfair, WA 98528