ABATE of VERMONT INC. - MEMBERSHIP APPLICATION   
7 Courtney Dr. Vergennes VT. 05491 PH. 802 877-8313

Full Member $20.00 per year - includes full membership packet, newsletter, 
and all benefits in accordance with  State By-Laws

Couples membership $25.00 will  receive only one newsletter

Associate Member $15.00  per year- this is available only
to additional members of a Full Members/Couples household. 
Will  not receive a newsletter

Member at Large $20.00 per year-includes membership packet, 
newsletter, and all benefits in accordance with State By-Laws

 Full Paid Life $125.00-Same benefits as Full Member / No annual dues 

   
 NAME________________________________________________  DOB_______/________/_______    
 
 ADDRESS____________________________________________________________________________

 CITY______________________________  STATE_____________________ ZIP:____________________

 PHONE (             )____________________________        EMAIL____________________________   

 In signing you agree to comply with ABATE of VERMONT’S  By-Laws, and 
 to promote safe motorcycle education, and activities in accordance with
 ABATE of VERMONT, INC.

 DATE________________   APPLICANT SIGNATURE_________________________________________

 NEW (  )  RENEWAL (  )      MEMBER #____________________

 DONATION FOR EDUCATIONAL PURPOSES?_____________________________

 All memberships will be on a 30 day trial basis.  
 If member is rejected after trial period we will retain 5 dollars for 
 administrative fees.  
 Rest of your money will be refunded in a 2-4 week period.      
                                                                                 
OFFICE USE ONLY. DO NOT WRITE

APPLICANT  ACCEPTED  (   )  YES   (   ) NO    

COMMENTS_____________________________________________________________________________

_________________________________________________________________________________________

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ABATE  0F VERMONT INC. MEMBERS RECEIPT         DATE:____________________
MEMBER#________  NAME OF APPLICANT_________________________________   
1 YEAR MEMBERSHIP  FROM_________ TO_____________  
FULL (   )   ASSC. (   )   MEM. AT LARGE (   )  LIFE MEMBER  (   )   
Retain this receipt, as proof of membership, until packet and permanent card 
is received .