Station 343 MEMBER APPLICATION

Please complete the application and mail to Fire and Iron Station 343, Att. Jim Young 2 Hansom Dr.

Merrimack, NH 03054 with a check in the amount of $70. Any further questions please E-mail Jim Young at secretary@fireandiron343.com

Name ________________________________________________________       

Address ______________________________________________________        

City, state, zip  _________________________________________________      

Phone/cell     ___________________________________________________

E-mail    _______________________________________________________

Name of Dept.   _________________________________________________    

Emergency contact and number    ___________________________________   

Are you being sponsored? If so who?    _______________________________   

Make/model of bike      ____________________________________________

Circle one      Rider / Passenger   

I THE UNDERSIGNED UNDERSTAND THE RULES AND RESPONSIBILITY OF MEMBERSHIP IN FIRE AND IRON MOTORCYCLE CLUB AND PLEDGE LOYALTY TO THE CLUB WITH THE BEST OF MY ABILITY!

Print Name ________________________________________  

Sign Name ________________________________________