Add New Member to Roster

Add New Member to Rosterchristine.pitre2022-11-01T21:58:52+00:00

Fill out this form to add a New Member to the MEMBER ROSTER.
This will also automatically add the New Member to MAILCHIMP.

First Name

Last Name

Road Name

Birthday MM/DD

Chapter State/Province

Chapter

Sponsor

Prospect Date

Patch In Date

Member Status

Out Date

Office

Secondary Office

Phone

Address

City/Town

State/Province

Country

Zip/Postal Code

Occupation

Motorcycle Details

Lodge of Record

Emergency Contact Name & Relationship

Emergency Contact Phone