Application for Membership

ABATE of Nebraska, Inc.

P.O. Box 30332, Lincoln, Nebraska, 68503-0332

____Membership Renewal

    Card #____________________($25)

____New Membership                      ($25)

____Associate Membership (18 yrs and younger)

    Sponsor Card #_____________($10)

____Supporting Business               ($50)

____Lifetime Membership              ($400)

Amount Enclosed (Check/Money Order ONLY) $_________

Date __________

Name ___________________________________________

Address _________________________________________

City/State/Zip ____________________________________

Phone __________________________________________

Email Address ____________________________________

___I am a registered voter in Nebraska

____I am an endorsed Motorcyclist in Nebraska or any other state

____I have taken a motorcycle safety or riders education course

        I understand by signing my name to this application, I am seeking membership into a motorcycle rights organization.

        Disclosure - Contributions made to the ABATE of Nebraska PAC Fund are NOT deductible as charitable contributions for federal income tax purposes.

            _______________________________________________________________________________________________________________________________

Signed_____________________________________________________________

Legislative District___________________________________________________

Recruited by:________________________________________________________