Application
(Print this page and mail it to the address below)
Name:
Address:
City / State
Zip:
Phone:
e-mail Address:
Club memberships (GWRRA, HOG, AMA etc.)
Types of Motorcycles Owned: (Touring, off road, sport bike)
Are you a registered voter?
Districts (if known)
House:
Senate:
What issues are you most interested in seeing VCOM address?
BASIC $25
Other classes of membership have expanded benefits:
SILVER SUPPORTER $50
All the basic benefits plus your name in each newsletter as a Silver Supporter.
GOLD SUPPORTER $75
All the basic benefits plus your name in each newsletter as a Gold Supporter and a framed certificate.
BUSINESS SUPPORTER $150
All the basic benefits plus your business address, phone number and brief description of your business in each newsletter, plus a static window "Business Supporter" sticker and framed certificate.
Organization Supporter $120
Lists your organization/club and contact number in each issue of the "VCOM News." Includes a framed certificate recognizing your organization/club.
Please make your check payable to:
Virginia Coalition of Motorcyclists
P.O. Box 4851
Richmond, VA 23220
The fees and funds collected by VCOM will enable this political action committee to actively and aggressively support state legislation that will improve the rights of all Virginian motorcyclists. Your support enables us to continue our work to maintain your right to ride.
Contributions are NOT tax deductible.
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