Finger Lakes BMW Club Membership Form

Primary Name Please Print!
Address 1  
Address 2  
City/State/Zip                                         , NY   ( Zip+Four: )
Residence Phone                                                If Unlisted               ( Include area codes )
Business Phone                                                If Emergency Only  ( Include extension )
Email Address  
Date of Birth I am willing to work at our rally!
My BMW is a Year:                 Model:                                              (Required for Primary)
Membership Numbers
if you belong
BMWMOA:                                BMWRA:                               
BMWVintage:                                AMA:                               
Newsletter: I prefer a PRINTED newsletter via US Mail rather than electronic PDF
Associate Name                                           
Business Phone                                                If Emergency Only ( Include extension ) 
Email Address  
Date of Birth I am willing to work at our rally!
My BMW is a Year:                 Model:                                              (Optional for Associate)
Membership Numbers
if you belong
BMWMOA:                                BMWRA:                               
BMWVintage:                                AMA:                               
Children List any children under the driving age (name/birthdate) who care to participate
Number of   Club Pins: ______     ( Primary/Associate only - 1 per person, max 2 )

I/we, the undersigned, certify that I/we own and operate a BMW motorcycle(s) and live within the area of New York State defined on the map, and generally, west of Interstate 81 and south of Pulaski.
SignaturesPrimary member:  
Associate member: 

The Annual Membership Fee is $15.00 for member and any associate. Associates are defined as a spouse or significant other who lives at the same address. Call it the "family plan." The associate member does not need to be a BMW owner. Valid email address required for electronic PDF newsletter. Make your check payable to Finger Lakes BMW Club and mail your form and check to:

Finger Lakes BMW Club
P O Box 35
Webster, NY  14580-0035 		Today's Date is: _____________________