Prospect Application for Membership with The

Prospect Application for Membership with the

Black Sabbath Motor Cycle Club

Last Name: ______First name: ______

Driver License #______Motorcycle Endorsement Yes / No (circle)

Marital Status (circle) S M D Living Together Gender Male - Female (circle)

Current Address: ______Apt/Suite# ______

City: ______State: ______Zip Code: ______

Phone Number Home: ______Cell: ______

(Please answer all below questions honestly, “NONE OF YOUR ANSWERS nor information provided on this application will be shared or disseminated to ANY outside agency.” Failure to answer ALL questions or providing false information will be grounds for rejection or termination from the Black Sabbath MC.)

1.  How or who did you hear about Black Sabbath MC Inc? ______

______.

2. Have you ever belonged to any other motorcycle club? If “yes”, what was the organization’s name, where and when? If “no” write N/A and proceed to question 5. ______

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3. If “yes” to question 2, why did you leave your former motorcycle club and did you leave in good standing?______Good Standing (yes)______(no)______

3. Do you own a motorcycle with a valid registration? Yes____ No_____

4. What type of motorcycle do you own? CC = _____, Make ______, Model ______, Year ______

5. What is your current occupation and working hours? ______

______.

6. Your Employer is: ______

Address ______

City______State ______Zip ______

7. Why do you want to join Black Sabbath Motorcycle Club? Briefly describe what you feel you can bring into this organization to assist us with reaching our goal of becoming the BEST MOTORCYCLE CLUB IN THE NATION!

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______.

______.

______.

Reference’s: (Please provide four (4) reference’s who do not live with you and you have known for 4 years or more)

Name Address Phone Number How long?

______.

______.

______.

______.

8.  Give a brief description of your thoughts on Community involvement, Family events, Long Distance Rides, Rider’s only events and what you’d like to see the Black Sabbath MC possess and maintain?

______.

______.

______.

______.

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9.  Emergency Contact Information (in case you go down someone who can make medical decisions on your behalf:

Name______Phone # ______

Relationship: ______

*Thank you for applying for membership to Black Sabbath MC Inc. We will be getting back to your within the next few days concerning the determination of your application. If there is anything which you forgot or feel would assist in the decision, please feel free to contact us @ 602.309.8278.

______Date: ______.

Applicant’s Signature