MJM Membership Application & Renewal Form

Please Print Form Here

 

Motorcyclists for Jesus Ministries

MJM Membership Application & Renewal Form

Motorcyclists for Jesus Ministries - is a ONE back patch organization.

OUR BACK PATCH IS NOT TO BE ADDED TO IN ANY WAY SHAPE OR FORM.

I.E. Identifying rockers, territory, T.E.A.M. names, etc. cannot be worn on the back of a members vest or jacket. Please print form and mail to:

 

mjm seal.JPG

 

Motorcyclists for Jesus

Ministries

c/o Fred Shafer Sr.

27 Bonneau Heights Road

Gettysburg, PA 17325

 

Yearly Dues; National  Singles-$25.00

                       Couples-$45.00

 

Outside the U.S-       Singles-$45.00

                       Couples-$60.00

 

Life Time Memberships Singles-$300.00

                        Couples-$450.00

MEMBERSHIP APPLICATION     /         RENEWAL FORM

Check Box that applies [  ]                                                                                [  ]

Name______________________________________________________     Date of Birth ___________

 

Iím/ We are born again Christian/s                   Check Box for Yes                    [   ]

 

Spouse______________________________________________________  Date of Birth ___________

( The definition of a Biblical couple, Constitutes one Man legally Married to one Woman )

 

Anniversary Date:         __________

 

Street Address: ____________________________________________________________

 

City: _________________________________ State: ____________ Zip: ____________

 

Applicants Day Phone: (____)_______________________                                               Fax: _______________________

 

Spouses Day Phone: (____)________________              Spouses Fax: _____________________

 

Applicants E-Mail: ________________________________                       Spouses E-Mail: ___________________________

 

Applicants Signature: ________________________________________

 

Spouses Signature: __________________________________________

 

Church Affiliation: _________________________________

 

MJM TEAM Member: _________________________________

 

Other Club Affiliation [s]: __________________________________________________________

Use the back for extra space to list all Clubs