Texas Motorcycle Rights Association

Membership Application

275 Old Lexington Rd.

Elgin, Texas 78621

PLEASE PRINT

Name / Names:_________________________________________________________________________

Address:_______________________________________________________________________________

City/State/Zip:____________________________________________Phone: ( )___________________

County:____________________________________________ Senate District # : ____________________

E-mail:_______________________________________________________________________________

Chapter: ______________________________________________________________________________

Membership Levels

( ) New - $30 for one year; receives (1) FREE sew-on patch. Renewal - $30 for one year

( ) Couple - $50 for one year, receives (2) FREE sew-on patch. Renewal - $50 for one year

( ) Individual Life - $400 for life, receives (1) FREE sew-on patch.

All levels of membership receive (1) Monthly copy of the Warrior.

Major Supporter Membership Levels

( ) Supporter - $100 ( ) Bronze - $250 ( ) Silver - $500 ( ) Gold - $1000 ( ) Platinum - $1500

My check/money order for $_________ is enclosed. Do not send cash!

( ) Please charge my credit card for payment in full of $_____________________. ( ) MasterCard ( ) Visa

No.________________________________________________________________Exp.______________

Signature:_________________________________________

Received membership patch: ( )Yes ( )No

Membership in Texas Motorcycle Rights Association.

Received from:________________________________________ the amount of ______________________

For: ( ) New-one year, ( ) Renewal-one year.( ) Couple-one year, ( ) Couple Renewal-one year. ( ) Life.

Signature:____________________________________________ (TRMA-2 Member)