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Pre-Membership Form

If Interested Please complete and send to

American Legion Riders, PO Box 26, Auburn, IN 46706

Name: _______________________________________

Nickname (optional): _______________________________________

Address: _______________________________________

e-mail (optional) _______________________________________

Phone Number: _______________________________________

Birth Date: _______________________________________

Legion Post Number: _______________________________________

Membership Number: _______________________________________

Type/Year Motorcycle: _______________________________________

Insurance Co. Name: _______________________________________

Policy Number: _______________________________________

Motorcycle Endorsement: Yes________ No__________

I attest that the above information provided

is true and correct to the best of my knowledge

Signed: _____________________________ Date:_____________

To complete the “Official Membership Application” you must attend a Legion Riders meeting, which are held the first Sunday of every month at 1pm. Membership dues are payable at the official signing and yearly each January.

Dues: $10.00 ALR Patches Large $35.00 Yes/No

US Flag: $4.00 Yes/No Small $10.00 Yes/No

P.O.W. $4.00 Yes/No Rockers Veteran $10.00 Yes/No

Squadron $10.00 Yes/No