Leave lines blank if it is info that you do not want to provide.
Name: ___________________________________________________________________ Birth Date:____________
Address: _______________________________________________________________________________________
City: _______________________________________________________________ State: ______________________
Zip Code: ____________ Email: __________________________________________________________________
Home Phone: ______________________ Work: ________________________ Cell: __________________________
Significant Other: _________________________________________________________ Birth Date: _____________
Children (at home): ________________________________________________________ Birth Date _____________
Children (at home): ________________________________________________________ Birth Date _____________
Children (at home): ________________________________________________________ Birth Date _____________
Motorcycle(s) year/make/model ----------- Sidecar(s) year/make/model
________________________________________________ / ____________________________________________
________________________________________________ / ____________________________________________
________________________________________________ / ____________________________________________
Average miles @ year ridden: Sidecar_____________________________ Solo__________________________________
Where do you like to ride? ___________________________________________________________________________
Ride Dates Preferred : Saturday? ____ Sunday? ____ Weekday? _______ Overnight? ______
Send check or money order in the amount of $18.00 to:
The Georgia Sidecar Club c/o Carl Shantz
PO Box 5574 Canton, GA 30114 Phone 770-851-8794
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