**PLEASE NOTE: By submitting this application, you are joining ABATE of OHIO, Inc. NO refunds will be made by ABATE of OHIO, Inc. for those who intended to join another state's ABATE or any other motorcycle rights organization (MRO). By submitting this application to ABATE of OHIO, Inc., you will become a full member, and as such, will have all rights and privileges of membership in our organization. If you want to be a member of ABATE in any other state than Ohio, please do not submit this form. Simply go the National Links Page, look for the listing of the state MRO you want to join and navigate tothe desired website.

Please use the 'Print' Command on your browser to print this form.
Fill out this form and mail it along with payment to the address below.
ABATE of OHIO, INC.
P.O. Box 29246
Columbus, Ohio 43229

$25 SINGLE Please Print Clearly

$40 COUPLE Date ___/___/___

Make Check Payable to: ABATE of OHIO, Inc.

Check if New Address

A.

Name:_______________________________________________________________________

B.

Name:_______________________________________________________________________

Address:________________________________________________________________________

City:____________________________

State:___________________________

Zip: ____________________________

County: _________________________

Phone: (____)_____________________

Birthday

A. ___/___/___

B. ___/___/___

RENEWAL

SINGLE

NEW MEM.

COUPLE

Registered Voter?

A. YES

NO

B. YES

NO

Licensed Motorcyclist?

A. YES

NO

B. YES

NO

OPTIONAL INFORMATION

Occupation:

A. _____________________________________________

B. __________________________________________________

Bike Type:

A.___________________________________________________

B. __________________________________________________

Email Address:

A __________________________________________________________

B. _________________________________________________________

Skills/Contacts:

A. _________________________________________________________

B. _________________________________________________________

In addition, would you like to make a contribution to the Motorcycle Riders Foundation? YES_____  I am enclosing $________________________ Please make check payable to: Motorcycle Riders Foundation

Application Taken By:______________________________________________   Rev 06/02