75 Years of Racing
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Membership Application Form
"
*
" indicates required fields
Date of Application
*
DD slash MM slash YYYY
Name
*
Sponsor's Name
*
Address
*
City
*
ZIP
*
Home Phone
*
Work Phone
*
Date of Birth
*
DD slash MM slash YYYY
Email Address
Age
*
Please enter a number from
1
to
70
.
Married?
*
Yes
No
If Yes, Wife's Name
*
Do you own a Motorcycle?
*
Yes
No
If Yes, What Kind and Size
*
Do you ride?
*
MOTO-X
DESERT
ENDURO
Other
What is your classification?
*
Expert
Amateur
Novice
Beginner
District-37 Riding Number
*
AMA Number
*
Experation Date
*
MM slash DD slash YYYY
Have you ever belonged to a motorcycle club?
*
Yes
No
If Yes, What Club?
*
How long were you a member?
*
Why did you quit?
*
Why do you want to join The Dirt Diggers M/C?
*
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Phone
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