2004 Membership Questionnaire
This information is to help
update our records and be able to provide you with the latest contact
information.
Dues are $15.00 for National
Full Member and $7.50 for National Associate Member.
You must have national member
numbers to be local chapter members.
National
Hog Number: US_____________
Name: _______________________ Nickname: ____________________
Spouse/Significant Other Name: __________________________________
Date of Birth (month/day): ______________ Anniversary: (month/day) _________
Contact Info:
Preferred Phone #1:
(___)____-_____[Home or Work] Please Circle Ok to Call? [Y or N]
Preferred Phone #2: (___)____-_____[Home or Work] Please Circle
Other things
you want us to know: ___________________________________________
________________________________________________________________________
________________________________________________________________________
Send a completed form along with the Chapter Enrollment form on page 2 when you
renew your dues. Send a photo of yourself and your bike and you may see it in
an upcoming newsletter or on the Superior Chapter Website at:
www.superiorchapterhog.com.
Return this form to a chapter meeting
or mail to: Call Joe Kerekes with
Bald Eagle Harley Davidson questions:
C/O Superior Chapter Marquette MI #1523 Home:
1-906-249-9492
2080 US41 West
Marquette MI 49855