BLOCK CAPITALS PLEASE

Name (1) ......................................................................................

Name (2) ......................................................................................

Address   ......................................................................................

                ......................................................................................

                ......................................    Post Code ...........................

Tel No. .......................................    D/O/Birth ................................

Membership No. if applicable ...............................    New/Renewal

Current Bike(s) ..............................................................................

Motorcycle insurance renewal date ...............................................

Membership Fee (Delete as applicable)

Individual / Joint / Family / Life                          £ ............

Donation                                                           £ ............

Total                                                                 £ ............

Please make cheque payable to MAG (UK)

Membership Rates

Annual   Individual - £20 Joint - £30

Family   Add £3.50 per child

Life       Individual - £200 Joint - £300

Children's Names ....................................................................

                           ......................................................................

Section below to be completed by all applicants

I/We apply for membership of MAG (UK) and agree to abide by the constitution, standing orders and rules of the group. I/We understand that MAG is committed to the eradication of motorcycle theft and declare that I/we will never participate in any form of motorcycle theft or the handling of stolen motorcycle parts. Membership details are strictly confidential and we do not sell or exchange address files, although your details may be made available to your regional organiser. If you do not wish to have your details made available to your regional organiser or receive details of other MAG offers please tick here |__|

Signature (1) ...................................................................

Signature (2) ...................................................................