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Gold Star Post 78 American Legion Riders Membership Form

Please enter your information in the spaces below:

Email Address

Required Info*

First and Last  Name

Aka (Nickname or Rider Name-Leave blank if you don't have one)

Current American Legion Member? If yes list either Legion, Aux or SAL member number and Post - ie Post 78 Legion #123456789*

Required Info*

Street Address

City
Country*
State/Zip Code*

Home Phone

Cell Phone

Emergency Contact Number*

About your bike (ALR Supporters leave blank)

Make

Model

Displacement

Liability Clause - By hitting the "submit" button, you certify the motorcycle listed above is registered in your name and in accordance with state, city, and/or local licensing and registration requirements. Also it certifies you carry property and liability insurance for you, passengers and the motorcycle. It also certifies you carry a valid motorcycle driver's license. IF my status changes, I will request, complete and submit a new Member Information Form.

 

 

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Drivers License Endorsement checked by and date

Registration checked by and date

Insurance checked by and date

Post 78 Membership checked by and date (Legion, Aux or Sons)

 

 

 

 

 

 

 

 

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