M.E.R.A. MEMBERSHIP APPLICATION

NAME___________________________________________________________

ADDRESS________________________________________________________

CITY___________________________STATE______________ZIP CODE______

TELEPHONE: DAYS____________________EVENINGS____________________

RIDING EXPERIENCE________________________________________________

RALLY EXPERIENCE_________________________________________________

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MOTORCYCLES CURRENTLY OWNED____________________________________

MERA#__________      DATE__________

Return the enclosed membership form, with your check for $24.00, if you would like to be part of this unique organization.

Make checks payable to: Steve Chalmers and mail them to: