Motorcycle Rider Information
* First Name * Last Name
MI Suffix (e.g., Sr., Jr., III, etc.)
* Date of Birth Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Nickname (Optional)
* Address Line 1
Address Line 2
* City
* State
* PostalCode
* Country
* Home Phone #
Cell Phone #
* Email Address
Back-up Email Address (Optional)
Do you own a motorcycle?
Have you taken a Motorcycle Safety Foundation training course?
If yes, in what year?
Primary Motorcycle Information
Year
Make
Model
* VINWE CANNOT GUARANTEE ROADSIDE ASSISTANCE WITHOUT YOUR MOTORCYCLE VIN!
(Associate or International Members, please enter "NONE".)
Secondary Motorcycle Information (Optional) This option cannot be used for a Significant Other/Spouse Member's bike.
Year
Make
Model
VIN WE CANNOT GUARANTEE ROADSIDE ASSISTANCE WITHOUT YOUR MOTORCYCLE VIN!
Membership Type and Fees
Membership benefits include a small IIRA patch, IIRA pin, subscription to our quarterly newsletter Smoke Signals , membership card, plus additional benefits as described on our web site.
* Please choose your membership type:
If this is a renewal, please tell us your membership number
Your Local IIRA Chapter (if applicable)
* If you live in the USA or Canada, please choose a Full Membership or Associate Membership.Outside the USA and Canada, please choose an International Membership .
$45.00 per year MUST
$45.00 per year NOT Smoke Signals . (Optional spouse memberships are still US$25 per year. We're sorry, no Associate Memberships are offered outside the USA and Canada.)
$35.00 per year NOT
Check here if you would like to add an optional membership for a Significant Other (e.g., spouse, child over the age of 16, girlfriend/boyfriend, etc.):
$25.00 per year May only be purchased with a Full, International or Associate Member in household. Does NOT
Significant Other First Name
Significant Other Last Name
Significant Other Nickname(Optional)
Comments or Special Instructions (Optional) AGREEMENT
I understand that there are inherent risks to riding a motorcycle and I agree, by submitting this application for membership in the Iron Indian Riders Association, a Non-Profit Corporation, to hold blameless the company, any of its officers and any of its members or agents, of and for any and all liability or claim of loss, that may be incurred from any loss, damage or injury (including death) to my person or property resulting by my membership or association with this organization.
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