2012 Manomet Mystery Riders Membership Application

By submitting this application, you agree to the following: I understand that Manomet Mystery Riders cannot assume responsibility for any aspect of my safety and that if I participate in any event, I do so voluntarily. On my own assessment of my ability, the routes, all facilities and conditions assuming all risk: I release and hold Manomet Mystery Riders, its members and officers harmless for any injury or loss to my person or property which may result there from . I also hereby certify that I am in compliance with my state's financial responsibility laws regarding carrying of proper insurance and licensing..

Membership dues are $30.00 for Standard and $50.00 for Gold and will be collected by a representative from Manomet Mystery Riders upon your acceptance.

Name:
Spouse/Partner:
Sponsor:
Address:
City:
State::
Zip Code:
Home Phone:
Business Phone:
Email Address:
Make/Model of bike(s):
Occupation:
Date of Birth:
Membership Type:	Standard $30.00 Gold $50.00
What type of Member:	New Current Previous
Other Club Affiliations:
I agree to the terms outlined above.