1) Print this Page.
( No printer?? E-Mail Me or call 1-800-25-BIKER to have a form mailed to you).
2) Fill out all information on this form ( please print clearly ).
("B" sections only for "couples" membership).
3) Mail completed application with your check or money order ($25 single / $40 couple) to:
ABATE OF OHIO, INC., P.O. Box 1658, Hilliard, OH 43026
Todays Date:______/________/________
Name:A) _______________________________________
B) _______________________________________
Address:_______________________________________________________
City, State, Zip:_______________________ ______ ____________
County you live in:_______________________
County Preference (if different than above):______________________________
Phone:(____)_______-____________ (_)Single (_)Couple
E-Mail ________________@__________ (_)Renewal (_)New Membership
Are you a registered voter? (Check one)
A)(_)Yes (_)no
B)(_)Yes (_)No
Are you a licensed motorcyclist?
A)(_) Yes (_)No
B)(_)Yes (_)No
Are you interested in information on the Motorcycle Safety Program?
A)(_)Yes (_)No
B)(_)Yes (_)No
Optional information
Occupation(s):_______________________________________________________
Type of motorcycle(s):_______________________________________________
Date of Birth(s):A)_____/_____/______
B)_____/______/______
Application taken by "T.J." via the Region Zero Web Page
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