APPLICATION FOR MEMBERSHIP

Surname:___________________First Name: ____________________Middle Name:

________________

Desired Codename: __________________ email address:

_____________________________________

Home Address: __________________________________

_______________________________________________

Office Address:
________________________________________________________________________

_____________________________________________________________________________________

Cell Phone: _______________________ _____________________________

_____________________

Notify in case of Emergency: ______________________________ relationship:

____________________

T.I.N. ___________________ Birthdate: (d/m/y) _______________________ Age:

________________
Civil Status: __________ Blood Type: ______ID No. ____________, date/place
Issued_______________
Other Affiliations:
______________________________________________________________________
_____________________________________________________________________________________
Referred by: ________________________________________________________(Club Member)

Rate Yourself as a Rider: ____________ (Nicky Hayden: 10, lowest rate is 1) Then we
rate you at the track. ______

BIKE DATA:

Manufacturer Make Year Model Displacement (cc)

I hereby certify that the above information is true and correct as of my knowledge
and based on authentic documents.
1x1 pic
________________________________________
Signature

n.b. This application must be accompanied by P2,000.00 for new applicants.