US MARINE RIDERS ASSOCIATION

U.S. MARINE RIDERS ASSOCIATION, INC.

MEMBERSHIP APPLICATION

(please print or type)

Date of Application: ____________________________________

Name: __________________________________________

Branch of Service: ____________________________________

Last Rank Achieved: ____________________________________

Years of Active Duty: ____________________________________

MOS(S): ____________________________________

Boot Camp Location: ____________________________________

Wars/Conflicts: ____________________________________

PLEASE SELECT MEMBERSHIP TYPE:

_____ Marine – Active Duty/Reserve _____ FMF Corpsman – Active Duty/Reserve

_____ Marine - Retired _____ FMF Corpsman – Retired

_____ Marine – Veteran _____ FMF Corpsman – Former

_____ Wife / Girlfriend _____ Wife / Girlfriend

_____ Support Element (Circle: Army, Navy, Air Force, Coast Guard, Civilian)

Heard about the USMRA from: _________________________________________

Address: __________________________________________________________

City: __________________________________________________________

State: ___________ Zip:_________

Contact Number(s): Home (_____) ____________ Cell (_____) _____________

Work (_____) ____________

Road Name: __________________________

Nick Name: __________________________

E-Mail Addres:_____________________________________________________

CORPSMAN MUST COMPLETE THIS SECTION:

Hospital Corpsman School, Dates and Location: _______________________________________________________________________

FMF, Dates and Location: _______________________________________________________________________

USMC Service Units Attached To: _______________________________________________________________________

MOS(S) and Description: _______________________________________________________________________

Have you ever ridden with another Motor Cycle Club, Organization, Association, etc.

Yes ______ No_____

If Yes, Name: ______________________________________________

Location: ______________________________________________

Reason for Leaving: ______________________________________________

Proof of Discharge, DD Form 214, MUST be enclosed

(Do Not Send Original)

APPLICATION ANNUAL DUES:

Annual Dues:

Marine or FMF Corpsman $ 25.00 $______________

Wife or Girlfriend $ 15.00 $______________

Support Element $ 25.00 $______________

Active Duty Members $ 15.00 $______________

Emblem (10”) $ 25.00 $______________

Patch (3 ½”) $ 7.50 $______________

Static Cling Emblem (3 ½”) $ 5.00 $___________________

Total Amount Remitted: $ ______

(Please make Checks made payable to:

U.S. MARINE RIDERS ASSOCIATION, Inc.)

I understated that the Emblem and all other U.S. Marine Riders Association materials, are the sole property of the U.S. Marine Riders Association, Inc., which is provided to you for a fee, on a temporary lease, and must be returned to the U.S. Marine Riders Association, should you leave, for whatever reason.

The undersigned (on my own behalf and on behalf of my heirs, personal representatives, successors and or assigns), for and in consideration of the opportunity to participate in a “Ride”, “Poker Run”, “Field Meet”, “Meetings”, or “Activity” herein, EVENT(S) sponsored and/or conducted by the U.S. Marine Riders Association, Inc., and their respective officers, directors, chairman, members and agents (herein, the “Released Parties”) release and hold harmless, the “Released Parties” from any and all claims and demands, rights and causes of action of any kind whatsoever which I now have or later have against the “Released Parties” in any way resulting from, arising out of, or in connection with my participation to any said EVENT(S).

This RELEASE, extends to any and all claims I have, or later may have against the “Released Parties” with respect to the EVENT(S) or with respect to the conditions, qualifications, instructions, rules or procedures under with the EVENT(S) are conducted or from and other causes. I UNDERSTAND THAT THIS MEANS THAT I AGREE NOT TO SUE ANY OR ALL THE ‘RELEASED PARTIES’ FOR ANY INJURY RESULTING TO MYSELF OR MY PROPERTY OR MY PASSENGERS FROM OR IN CONNECTION WITH SAID EVENTS(S).

Signature:________________________________Date:_________________________

Please forward your Application, DD Form 214,

and Monies to: