Akron BMW Motorcycle Club #21

Please print clearly

Name:

Address:

City:

State:

ZipCode:

Phone:

Other:

E-mail:

BMWMOA #

Dues are due before January 31st of each year.

Amount enclosed: ($10.00 per year)

I am interested in (please check all that apply):

Poker Run, Spring

Poker Run, Fall

"Overnight" Rides

"Local" Rides

Mid Ohio

Travel

Dinners

Social Activities

Club office or Committee

?

Other:

?