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MEMBERSHIP APPLICATION
FIRE AND IRON MOTORCYCLE CLUB
STATION 857
(please print)
DATE:__________________
NAME:___________________________________________________________
ADDRESS:________________________________________________________
HOME PHONE:____________________________CELL PHONE:_____________________________
E-MAIL:__________________________________
EMERGENCY CONTACT NAME & NUMBER:__________________________
__________________________FIRE DEPT:_________________________________active___ retired___
EMPLOYER: (sponsored applicant only)_________________________________
IF SPONSORED, SPONSORES NAME:_________________________________
MAKE, MODEL,OF BIKE:_________________ _________________________________
I, the undersigned, understand the rules and responsibilities of membership in Fire and Iron Motorcycle Club and pledge loyalty to the club. I understand Station 857 or Fire and Iron is not responsibly for any damage or injuries sustained during rides, events, and ALL functions of Station 857 and Fire and Iron.
PRINT NAME:______________________________________________________
SIGN NAME:_________________________________________DATE:_________
SPONSORS NAME:____________________________________DATE:________
PRESIDENTS SIGNATURE:_____________________________DATE:________
Please mail completed form with $100.00,(includes $25.00 for annual dues, $75.00 for club patches, and a tee shirt) to:
Fire and Iron, Station 857
26 Beech Street
Winchendon, Ma 01475
Att: Ricci B. Ruschioni
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