Name:

  Address:

  City:                                             State:                                    Zip:

  Phone#:                                        CellPhone#:

  E-Mail Address:                                                                          Age:

  Brief history of yourself: (Include any military service,current employment

  and membership in any other motorcycle club)

  Are you legally licensed to operate a motorcycle?       Yes        No

  List type                                Year               Model                        CC's

  How many years of experience do you have as an operator/rider?

  Explain why you are interested in becoming a member of the Delaware Chapter

  of Buffalo Soldiers Motorcycle Club

   Signature of Applicant:

   Name of Sponsor        

DELAWARE BUFFALO SOLDIERS MOTORCYCLE CLUB

MEMBERSHIP APPLICATION

(JOIN US AND SHARE OUR HERITAGE)