This form is printable. Please print and mail to:

GWRRA RI Chapter A
Vincent Isabelle
9 Hattie Brown Lane
Bristol, RI 02809

Chapter Participation & Sunshine Donation Form

                                             Rhode Island Chapter A

Rider’s Name_________________________________________________

Date of Birth__________________________________________________

Co-Riders Name_______________________________________________

Date of Birth__________________________________________________

Address______________________________________________________

City/Town____________________________________________________

State/Zip_____________________________________________________

Home Phone__________________________________________________

Cell_________________________________________________________

E-Mail Address________________________________________________

1st Type/Model/Year of Motorcycle__________________________________

2nd Type/Model/Year of Motorcycle__________________________________

GWRRA Membership #_________________________________________

Co-Rider Membership #_________________________________________

May we use this information in a chapter directory? YES______NO______

 

Optional Sunshine Fund Donation
$7.50 per person
$15.00 per Family

Total Attached: $____________
Please make checks payable to GWRRA Chapter A Rhode Island


IMPORTANT: all participants must sign this

I /we understand that the Gold Wing Road Riders Association Chapter A Rhode Island or any
member of cannot assume any responsibility for any aspect of my safety. I understand that my
participation in any activity is strictly voluntary and I/we hold harmless from any loss to me/our
person or property.

Rider Signature __________________________________Date________________

Co-Rider Signature _______________________________Date_________________

Any information about yourself that would be helpful to our chapter please list it below.

 

 

 

 

 

 

Do not write below this line
_____________________________________________________________________

GWRRA Chapter Card Number Rider____________________

Co-Rider__________________
Date________________
Check #_____________