Print this form and bring it to our next meeting or
Send it along with a check for your membership fees to: (see below)

Ozark Vintage Motorcycle Association
1207 NE 3rd Street Bentonville, AR 72712

Membership No: 
Mailing Address: 
Home (      )                                             Business (       )
Cell: (     )                                            E-Mail Address:
Vintage Motorcycles Currently Owned:
 Emergency Contact:                                                               Telephone: (     )
Membership Fees
January 1, 2017 - December 31, 2017
Single Membership
Couples Membership
Total Enclosed

Fees will be prorated at each quarter if joining after the first quarter of the year.

I (We) hereby agree to abide by the rules set out in this association of the Ozark Vintage Motorcycle Association and not to hold the association or any of the officers of the association responsible for any damage or injury during any association activities or events.


_____________________________________________        ____________________
                  Signed                                                                                               Date