FREEDOM RIDERS U.S.A.
Riding Club
Prospect Application
Last name: __________________________
First name: _______________ MI__
First name: _______________ MI__Address:____________________________________________
____________________________________________ ____________________________________________Spouse/significant other's name: __________________________________
Phone: (home)______________________(cell)_____________________
(cell)_____________________Email:_____________________________________________
_____________________________________________Check one: ___Active public safety___Retired public safety
___Retired public safety ___Active duty military ___Retired military ___Spouse of member ___VeteranPublic safety agency / branch of service/years of service: _______________________
Year/make/model of motorcycle: _______________________
Who or what introduced you to the club? _______________________
Have you ever been convicted of a felony?_____
_____Have you ever been a member of or affiliated with a 1% support group? _____
I understand that my application for prospect status does not guarantee approval of full membership in the FREEDOM RIDERS USA and that approval of membership requires
that I read, understand and abide by the Club By-Laws. A club member is normally
required for introduction and sponsorship to the club. Application must be submitted
with initiation fee (see sponsor for details). Application is not required to attend club
meetings or rides.
___________________________________________Received by: ________
Received by: ________SignatureDate Initials/date
Date Initials/dateFreedom Riders USA
P.O. Box 93
Quaker Hill, CT 06375
