Common Courtesy RIDE CLUB Registration Application
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First Name and Middle Initial *
Last Name *
Street Number and Name *
City *
State *
Zip Code *
Email *
Is this Rider Email or other Contact?
Cell Phone Number (Riders MUST carry a mobile phone for safety) *
Ex: 555-555-5555
Emergency Contact Information
Please list two nearby and available contacts
Name, Telephone, Relationship *
Ex: George Washington, 555-555-555, Son
Name, Telephone, Relationship *
Ex: Gloria Smith, 555-555-555, Sister
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