Crow Canyon MX

MEMBERSHIP APPLICATION
MEMBERSHIP DEFINITIONS
*Click here to read Membership Definitions before filling out the form below
APPLICATION INFORMATION
*Name:
*Date of Birth:	*Phone:
*Current Address:
*City:	*State:	*Zip:
*Email Address:
*Type of Membership: Voting Member $300
*Type of Vehicle(s): ATV Motorcycle UTV
*Type of Riding: MX Trail
GENERAL INFORMATION
*Do you have a valid US citizenship?
*Have you ever been convicted of a felony or other crime?
*Do you have any type of serious medical conditions?
List Medical Conditions if Applicable?
EMERGENCY CONTACT
*Name of Emergency Contact:
*Current Address:		*Phone:
*City:	*State:	*Zip:
*Relationship:
ASSOCIATE MEMBERS - $50.00 PER ASSOCIATE MEMBER (UP TO 6) IMMEDIATE FAMILY AND/OR GIRLFRIEND ONLY
Associate 1 Information Name:
Current Address:		Phone:
City:	State:	Zip:
Relationship:		Date of Birth:
Associate 2 Information Name:
Current Address:		Phone:
City:	State:	Zip:
Relationship:		Date of Birth:
Associate 3 Information Name:
Current Address:		Phone:
City:	State:	Zip:
Relationship:		Date of Birth:
Associate 4 Information Name:
Current Address:		Phone:
City:	State:	Zip:
Relationship:		Date of Birth:
Associate 5 Information Name:
Current Address:		Phone:
City:	State:	Zip:
Relationship:		Date of Birth:
Associate 6 Information Name:
Current Address:		Phone:
City:	State:	Zip:
Relationship:		Date of Birth:
REFERENCES (FOR VOTING MEMBER)
Name:	Address:	Phone:
*	*	*


SIGNATURES
I authorize the verification of the information provided on this form for my membership. By putting your name below and submitting the form, the voting member agrees to uphold ALL club rules, terms and conditions and is responsible for their own actions. By signing, the voting member also will make sure all associate members uphold ALL club rules, terms and conditions and the voting member is responsible for each associate members actions.
* Click Here to Read Rules, Terms and Conditions - By checking here I acknowledge that I have read and Accept the Crow Canyon Motorsports Club LLC, Rules, Terms and Conditions and I fully understand each and every rule. I have signed thies Acknowledgement freely and voluntarily without any inducement, assurance, or guarantee being made by me.
* Signature of Applicant:		* Date:
SUBMIT APPLICATION FOR APPROVAL

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