Member Information Form/Application for Membership

About You: Complete this section in its entirety.

CHECK ONE: 

Currently Member of:     LEGION ______      SAL ______      AUX______

            at Post # ___________ Membership #: __________________

 

Last Name: ______________________________  First Name: _______________________

Nickname/Rider Name: _______________________________________________________

Home Address: __________________________________________ Apt: _______________

City: ______________________________ State:___________   Zip: ______________

Birth Date: _____________________________     

Home Phone: (518) _________________    Cell Phone: (518) ____________ญญ_________

                               Email address: ________________________________

SPOUSE NAME: _________________________________________________

EMERGENCY CONTACT ______________________   PHONE: ____________

 

 

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Draw a large "X" through the section that does not apply to you.

Complete this section if you will be operating a motorcycle with the ALR.

Make: _________ Model: _ ____________ Displacement: ____

I, the undersigned, certify that the motorcycle listed above is registered in my name and in accordance with state, city, and/or local licensing and registration requirements. I further certify that I carry property and liability insurance for myself, my passengers, and my motorcycle which meets at least the minimum state, city, and/or local insurance requirements. I also certify that I carry a valid driver's license with either a cycle endorsement or a valid Motorcyclist Temporary Instruction Permit in accordance with state, city, and/or local laws. If my status changes, I will request, complete, and submit a new Member Information Form.

 

Complete this section if you are joining as a passenger of the following Rider:

                              _______________________________________ .

I, the undersigned, will not be operating a motorcycle as an American Legion Rider, but may be participating in American Legion Rider events as a passenger. If my status changes, I will request, complete, and submit a new member Information Form.

 

AND, I agree that the American Legion, and the American Legion Motorcycle Association (henceforth referred to as 'The American Legion Riders' or simply as 'Riders'), shall not be liable or responsible for damage to property or injury to persons including myself during any Riders activities, even where the damage or injury is caused by negligence (except willful neglect). I understand and agree that all Riders members and their guests participate voluntarily, and at their own risk in all Riders activities. I release and hold the Riders officers and the American Legion harmless for any injury loss to my person or property that may result through my participation in the Riders and/or their activities. I understand that this means that I agree not to sue the Riders officers, whether local, state or national, nor the American Legion for any injury resulting to myself or my property in connection with Rider's activities.

All members must signify their understanding and certification of the relative section above by signing and dating here.

Signed: ______________________________________       Date: ___________________