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COUNTRY BOY RIDERS MEMBERSHIP APPLICATION
CURRENTLY WE ARE ONLY ACEPTING APPLICATIONS FOR MEMBERSHIP FROM NC, SC, AND VA RESIDENTS ONLY. The monthly membership dues are $5.00 for the ladies and $10.00 for the men. Dues are due the 15th of each month. Mail Payments to P.O. Box 574 Atkinson NC 28421. For further information Contact the Treasurer.

First Name
Last Name
Aliases

Address

Home Phone
Work Phone
Cell Phone
Pager

Email Address
Age
Birth Date
Sex
Male
Female



Do you own a bike?
yes
no
If yes, what is make and model: Model
Do you own a Truck?
yes
no
If yes, what is make and model: Model
In consideration of acceptance of the application, I hereby agree to waive any and all claims against Country Boy Riders, it's officers, board members, and general members for loss or damage which may occur to me or my property as a result of my participation in Country Boy Riders Club functions. I understand that Country Boy Riders Club can not and will not assume responsibility for any aspect of my safety and that, if I participate in any Country Boy Riders sponsored ride or event, I do so voluntarily on my own assessment of my ability, to course, and all conditions, assuming all risks, and I release and hold Country Boy Riders harmless for any injury or loss to my person or property which may result therefrom. I further agree not to sue Country Boy Riders or any property owner on whose property such injury or damage may occur in any court of law for any injury to myself or my property and I agree to reimburse Country Boy Riders for any and all losses it may suffer as a result of my own or guests' participation in any Country Boy Riders sponsored event.
YOU WILL BE CONTACTED IN REGARDS TO YOUR MEMBERSHIP STATUS