X-RIDERS
MEMBERSHIP APPLICATION

Lifetime membership dues are $3.00 US (three US dollars). 
Entitles member to participation in the virtual clubhouse and 
establishment of their own local club chapter.


Name:__________________________________ Nickname: _______________

Address: ________________________________________________________

City: ________________________  State/Country:  _________________

Zip: _____________________   Phone: _____________________________

E-Mail Address: _________________________________________________

Motorcycle Make: __________________ Model: ______________________

Year: _______________________ Engine Size:  _____________________

Signature represents acceptance of X-Riders Rules of Conduct.


___________________________________________________
Member Signature

Membership info will be sent upon receipt of dues. Please remit 
the membership dues and completed application form to:

X-Riders 
13242 N. 38th Place
Phoenix, Arizona, 85032, USA.

Make Checks Payable To: DAVID HASS                  

ver:01-30-2003