Reynlow Riders
Application for Membership

Application fee should be sent via Venmo to Reynlow Riders at the location below:
https://Venmo.com/Reynlow-Ryders

Individual fee: $100
Each additional person fee: $25
Social membership fee: $20

Or, scan the QR code to make your payment:

Be sure to include your full name and membership year in the payment note.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email

Phone

(###)

###

####

Bike/ATV

Birth Date

MM

DD

YYYY

Health Insurance

Please check the box below to confirm that you (and your family, if applicable) have health insurance.

I confirm that I (and my family, if applicable) have health insurance and will maintain coverage through this calendar year.

If Family Membership, include all family member names below.

• $100 for first member, plus $25 for each additional member. • All individuals must sign their own Release Form and Liability Waiver. • If this is NOT a Family Membership, you may skip the following section and proceed to submit.

Name (family member 1)

First Name

Last Name

Birth Date (family member 1)

MM

DD

YYYY

Bike/ATV (family member 1)

Name (family member 2)

First Name

Last Name

Birth Date (Person 2)

MM

DD

YYYY

Bike/ATV (family member 2)

Name (family member 3)

First Name

Last Name

Birth Date (family member 3)

MM

DD

YYYY

Bike/ATV (family member 3)

Name (family member 4)

First Name

Last Name

Birth Date (family member 4)

MM

DD

YYYY

Bike/ATV (family member 4)

Reynlow RidersApplication for Membership

⚠️ IMPORTANT NEXT STEPS ⚠️

Reynlow Riders

Reynlow Riders
Application for Membership