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Iron Indian Riders Association - A Non-Profit Corporation
Membership Application
Fields marked with an asterisk (*) are required.
| Motorcycle Rider Information | ||
|---|---|---|
| * First Name: | ||
| * Last Name: | ||
| MI: | ||
| Suffix (e.g., Jr., Sr., III, etc.): | ||
| * Date of Birth: | Year (YYYY): | |
| Nickname (optional): | ||
| * Address1: | ||
| Address2: | ||
| * City: | ||
| * State: | ||
| * ZIP/Postal Code: | ||
| * Country: | ||
| * Home Phone Number: | ||
| Cell Phone Number: | ||
| * Email Address: | Secondary Email Address (optional): | |
| Are you a motorcycle owner? | Yes No | |
| Have you taken a Motorcycle Safety Foundation training course? | N/A Basic Advanced | |
| If so, in what year did you take the course? | ||
| Primary Motorcycle Information | ||
| Year: | ||
| Make: | ||
| Model: | ||
| * VIN: | ||
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Secondary Motorcycle Information (Optional) (This option is an additional US $5.00) This option cannot be used for a Significant Other/Spouse Member's bike. This option is for a Full Member only. |
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| Year: | ||
| Make: | ||
| Model: | ||
| 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. |
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| * Please choose your membership type: | New Member Renewal | |
| If this is a Renewal, please provide your existing IIRA membership number: | ||
| Your local IIRA Chapter (if any): | ||
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* Please choose a Full Membership or Associate Membership. Prices listed are for new and renewing members. ATTENTION INTERNATIONAL APPLICANTS!!! |
US $45.00 per year Full Membership (Registered Motorcycle Owner) In addition to the membership benefits noted above, a Full Membership includes Roadside Assistance (RSA). You MUST own or purchase a Motorcycle and register your VIN with us to receive all benefits of the Full Membership. US $35.00 per year Associate Membership (for non-motorcycle owners OR those who do not want RSA) Does NOT include Roadside Assistance (RSA). You may upgrade from an Associate Membership to a Full Membership for an additional US$20.00 anytime during the first 9 months of being an Associate Member. Your Full Membership would start on the date of upgrade and be valid for one year from that date. |
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| 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.): |
US $25.00 per year Significant Other Membership May only be purchased if there is already a Primary or Associate Member in household. Does NOT include Road Side Assistance (RSA) or subscription to newsletter. |
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| Significant Other First Name: | ||
| Significant Other Last Name: | ||
| Significant Other Nickname (optional): | ||
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| Comments or Special Instructions (Optional): | ||
| AGREEMENT |
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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.
* (This box must be checked in order for this Membership Application to be complete.) | ||
Mail this application and your check or money order to:
Iron Indian Riders Association
Membership Services
PO Box 341
Mira Loma, CA 91752
Once we receive your application, we will process it and contact you immediately. If you have any questions about this application, you may contact us at membership@ironindian.com or write to the address above.
Thank you, IIRA Member Services