Application for Membership 

    Date _______________________________________________________

Name ______________________________________________________

Address ____________________________________________________

City _______________________________________________________

Phone _____________________________________________________

E-Mail _____________________________________________________

What issues are you most interested in seeing VABA address? _________
___________________________________________________________

___________________________________________________________

___________________________________________________________

New members require a sponsor from a current VABA member:

Sponsor ____________________________________________________

Membership renewal requires this form to be completed.  Due by July each year.

Please print this form, and mail your application and check payable to VABA to:

VABA

P.O. Box 1591

Hillsville, VA  24343

The funds collected by VABA will enable this organization to actively and aggressively

support state legislation that improves the rights of all Virginia motorcyclists.  Your

support enables us to continue our work to maintain your right to ride.