Membership Application

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Owners Club of Southern California

Membership Application

Date ______________  Annual Dues $ 30. (Over Seas $35.)

Name ____________________________________________  

Address__________________________________________              City______________________________________________  Zip__________________   Phone _____________________ 

Country _______________  Postal Code _______________

 E-mail address______________________________  

Circle one:    New member       Renewal      Reinstatement Reinstatement    (expired over one year) prior # __________ 

 Motorcycles owned:

#1________________________ #2______________________

#3________________________#4_______________________  Mail this form with Check to:

BSA Owners Club of Southern California

14140 Estero Rd.

Victorville  CA  92392-9768

 

Club Use Only

Pin Issued_______  Payment Type_________

Date ______________  Rec'd by____________