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ABATE of Florida Inc SOUTHWEST CHAPTER
49
Membership Application
ABATE OF FLORIDA, Inc. SOUTHWEST CHAPTER
ABATE of Florida Inc.
SOUTHWEST Chapter
PO Box 60745
Fort Myers, FL 33906
Att: Trudy Rabell
Name: ________________________________________________________________________________
Address: ______________________________________________________________________________
City: ________________ State: ______ Zip: _________ Phone: __________________________
E-Mail: _________________________________________ Sponsored By: ________________________
Sign: ______________________________________________________________
Voter District: ________ Are you a registered voter? Yes ( ) No ( ) State District: ________ Do you want your newsletter e-
mailed? Yes ( ) N0 ( )
State House District: ________ US Congressional District: ________Do you have a motorcycle endorsement? Yes ( ) N0 ( )
Do you currently ride? Yes ( ) N0 ( ) Do you have time and talent to spend helping the Southwest Chapter reach its goals?
Yes ( ) N0 ( ) If so explain how you can help.
________________________________________________________________________________________________
Membership Dues (Please check one)
New Member $20.00 ( ) Renewal $20.00 ( )
Lifetime Membership $150.00 ( )
Mail this completed form and a check or money order, made payable to ABATE of Florida, Inc. SOUTHWEST
Chapter, and send to the address above. Membership is open to anyone 18 years of age or older who is interested in promoting
FREEDOM OF CHOICE whether or not you ride. ABATE is non-discriminatory and insures your opinions
on motorcycle
legislative issues will be heard.
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