United Riders Federation: Membership Form Chapter

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UNITED RIDERS FEDERATION

MEMBERSHIP FORM
Chapter: ________________________
Personal/Drivers Information
________________________________________ ___________________ ___________________
(Last Name, First Name, Middle Name) (Nickname, Alias) (Date of Birth)
___________________________________________________________________________________
(Address)
________________________________________ ___________________ ___________________
(Contact Number) (Gender) (Civil Status)
________________________________________ ________________________________________
(E-mail: If Applicable) (Occupation)
________________________________________ ________________________________________
(License Number) (Expiration Date of License)

Motorcycles Information
__________________________ __________________________ __________________________
(Make/Brand) (Series/Model) (Plate Number)
________________________________________ ________________________________________
(Engine Number) (Chassis Number)
________________________________________ ________________________________________
(Owners Name) (Place of Registration)

OBRs Information
________________________________________ ___________________ ___________________
(Last Name, First Name, Middle Name) (Nickname, Alias) (Date of Birth)
___________________________________________________________________________________
(Address)
________________________________________ ___________________ ___________________
(Contact Number) (Gender) (Civil Status)
________________________________________ ________________________________________
(E-mail: If Applicable) (Occupation)

-----------------------------------------------------------------------------------------------
I, _______________________________________,
(Name of Aspirant/Member) Received/Reviewed by:
certify that the above information is true and
correct. _______________________________________
(Signature over Printed Name)
Position:
________________________________________ _______________________________________
(Signature)
Date:
________________________________________ _______________________________________
(Date)

Note: Any false details found in this form may cause the termination of application or membership to the
UNITED RIDERS FEDERATION. Please check and verify before submitting this form

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