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Buffalo Soldiers MC | Richmond, Virginia

P.O. Box 25398 Richmond, VA 23260

Membership Type: Full Member ⃝ Associate Member ⃝

Last Name: First Name:

Email Address:

Address:

City: State:

Zip Code: Home Phone:

Cell Phone: Work Phone:

Date of Birth

Emergency Contact Name: Phone:

Motorcycle Information
Motorcycle/ Trike Year & Make:

Motorcycle/Trike Model:

M, M2, or M3 License Class: License No.:

Insurance Carrier:

Experience
Beginner (2 years or less): Intermediate (2 – 5 years)

Advanced (6 – 8 years): Seasoned (8 years or more):

Longest distance ridden in a Destination:


single road trip.
No. of Miles: No. of Days:

Have you ridden with a group?


Buffalo Soldiers MC | Richmond, Virginia
P.O. Box 25398 Richmond, VA 23260

Provide a brief history about yourself and tell us why you are interested in becoming a member of our
organization?
_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

❖ Are you currently a member of another motorcycle club or social club?

❖ Have you been a member of another motorcycle club within the past 12 months?

If yes, name of motorcycle club _________________________________________

❖ Have you been convicted of a crime within the last 5 years?

If yes, please explain. _____________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

❖ References: ____________________________________________________________________

______________________________________________________________________________

Colors are the property of Buffalo Soldiers MC Richmond VA, and they are on loan to you. If you terminate your
membership with the Buffalo Soldiers Motorcycle Club of Richmond, Virginia, you agree to return all colors within
30 days of your termination. The club will refund you ½ the cost of what was paid for your colors. If you have not
returned your colors within the 30 days, you will be accessed a $500 fine, and the club may do what is deemed
necessary to collect the fine.

I certify that I have read, understand, and agree to all terms stated.

Name (Print): _________________________________________________________________________

Signature: ____________________________________________________________________________

Official Use Only:


Membership ID Number: ________________________
Membership Date: _____________________________
Retirement Date:_______________________________

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