ABATE of Ohio, Inc. membership application

ABATE of Ohio, Inc. application for membership.

1) Print out form. (No printer?? E-Mail Me or call 1-800-25-BIKER to have a form mailed to you).
2)Fill out all information on this form ("B" sections only for "couples" membership).
3)Mail completed application with your check or money order ($25 single / $40 couple) to:
ABATE OF OHIO, INC., P.O. Box 29246, Columbus, OH 43229

Date:______/________/________

Name:A) _______________________________________

. . . ..B) _______________________________________

Address:_______________________________________________________

City, State, Zip:_______________________ ______ ____________

County you live in:_______________________

County Preference (if different than above):______________________________

Phone:(____)_______-____________ (_)Single (_)Couple

E-Mail ________________@__________ (_)Renewal (_)New Membership

Are you a registered voter? (Check one)
A)(_)Yes (_)no .... B)(_)Yes (_)No

Are you a licensed motorcyclist?
A)(_) Yes (_)No .... B)(_)Yes (_)No

Are you interested in information on the Motorcycle Safety Program?
A)(_)Yes (_)No .... B)(_)Yes (_)No

Optional information

Occupation(s):_______________________________________________________

Type of motorcycle(s):_______________________________________________

Date of Birth(s):A)_____/_____/______ B)_____/______/______
Application taken by "T.J." via the Mahoning County Web Page