MEMBERSHIP APPLICATION

First Name: Last Name:

Street Address:

City:   State:   Zip:

Email Address:

Local Chapter Name (if known):

Local Chapter City (if known):   Local Chapter State (if known):

Membership Type:

Free Window Sticker with 1 year paid membership
Free Tee-Shirt with 5 year paid membership
Free Window Sticker and Tee-Shirt with paid Lifetime Membership
No Merchandise Included With Free Membership!

Second Family Member Name if applying for more than one Membership: (Must be over 18 years of age and reside in same household)

First Name: Last Name:

Receive 50% off Second Family Member Membership (will be reflected on Invoice)

 

An email will be sent once your application has been reviewed by a member of GeekRiders.com

Upon membership approval, a statement will be emailed to the address provided, and you have 30 days to submit payment before your membership will be sent to an "Inactive Status"

Invoice will specify what size T-Shirt's to be mailed to your home upon receiving payment.  Please make sure that shirt (s) size is marked clearly on invoice when returning payment.

By checking this checkbox, I agree to all rules and regulations of the Geek Riders Bike Club Charter

Agree to Terms and Conditions of Membership