Chapter 221 SCRC
Membership Application

Southern Cruisers Riding Club • Lawrenceville, Georgia • Free to Join • All Bikes Welcome

Before you apply: Membership in Chapter 221 SCRC is free. There are no dues, no fees, and just come to 1 meeting per year and you are set. You are welcome to ride with us anytime without being a member. This application is for riders who want to officially join the chapter and receive their SCRC patch.

Type Background Number

Full Legal Name

Street Address

City

State

Country

Leave blank if USA

Postal Code

Phone Number

My Number Is Unlisted

Email Address

Confirm Email

Not shared with anyone outside of the SCRC

Gender

I Live In a Different State But Choose To Ride In This Chapter

Bike Make

e.g. Harley-Davidson, Honda, Yamaha, Kawasaki

Bike Model

e.g. Softail, Shadow 750, V-Star 1100

Nickname / Road Name

What do riders call you?

Delphi Name

Your Delphi forum username, if applicable

AMA Membership Number

AMA Members Only — leave blank if not applicable

Alternate Contact Information

Secondary phone, mailing address, or other way to reach you

Emergency Contact Name

Emergency Contact Relationship

e.g. Spouse, Parent, Sibling, Friend

Emergency Contact Phone Number

How Did You Hear About Us?

General Liability Disclaimer — Please Read Carefully Before Submitting

Background Confirmation (Required)

I have not been convicted of any violent or sexual offenses.

You must check this box to submit your application.

Type "I Agree" in this box to acknowledge you have read and agree to the SCRC Constitution

Required — type the words: I Agree

Chapter 221 SCRCMembership Application

Chapter 221 SCRC
Membership Application