Red Knights Motorcycle ClubÒ

Mass Chapter 3

380 Main Street Plympton, MA 02367

APPLICATION REQUEST

Print this page, complete all sections, and mail it to the address above.

Do not send money

NAME: _________________________________    DATE: ______________________

ADDRESS: ______________________________     TOWN: ______________________   

ZIP: ____________    

E-Mail: ___________________________________

HOME PHONE: _____________________

CELL PHONE: ______________________

Significant other: ________________________________________

FIRE DEPARTMENT AFFILIATION: ______________________________

I certify that the above named individual is an active/retired member in good standing with the ____________________________________________ fire department at the present time.

___________________________________________

(Signature of department chief or sponsoring member)

Sponsoring member: ___________________________

Application fee: $5.00

Membership Fee: $25.00

Payable at membership voting meeting

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Membership committee only

After investigation of the above named individual, we, the membership committee (recommend/reject) this applicant for membership.

Member status:    Active    Associate   Social

Membership number: ________

Committee Representative: _________________________

Date: ___________