join – District 36 Motorcycle Sports Committee, Inc.

Membership

DISTRICT 36 MEMBERSHIP APPLICATION

* denotes required fields
Is this a renewal application?*
- Yes
- No
Membership Category (select one)*
Membership Fees include a $3 Processing Fee. Total fees are calculated at check-out. Please Note: Family membership is for one household, 2 adults and children 17 YEARS OLD and UNDER living in the same home.
Primary Discipline*
Select the level ( C, B or A ) and Primary Discipline ( Cross Country, Grand Prix, Hill Climb, Enduro, Dirt Track or MX )
- C - Cross Country
- B - Cross Country
- A - Cross Country
- C - Grand Prix
- B - Grand Prix
- A - Grand Prix
- C - Enduro
- B - Enduro
- A - Enduro
- C - Dirt Track
- B - Dirt Track
- A - Dirt Track
- C - Hill Climb
- B - Hill Climb
- A - Hill Climb
AMA Number
If a member of AMA enter your AMA Number
District 36 Number*
Enter your current District 36 number here (example 123A)
Name*
First Last
Mailing Address*
Mailing Address City State ZIP Code
Email*
Phone*
Gender*
- Male
- Female
Date of Birth*
MM slash DD slash YYYY

MM/DD/YYYY
Hold Harmless Agreement*
By Submitting this Membership Application I agree to comply with District 36 and AMA rules for sanctioned motorcycle activities. I understand that District 36 and the American Motorcyclist Association cannot assume responsibility for any aspect of my safety and that if I participate in any sanctioned meet, I do so voluntarily on my own assessment of my ability, the track, course and all facilities and conditions, thereby assuming all risk. I release and hold District 36 and the American Motorcyclist Association harmless for any injury or loss to my person or property which may result therefrom. I also attest that I have full authorization to add family members to this application, I have explained to them this liability release and that they agree to comply with these terms.

By checking this box and typing in my name below I attest that I have read and understand and agree to the above terms for membership in District 36. I also attest that the name typed in the signature boxes below is the legal one for the applicant. (A parent/legal guardian must ‘sign’ for any applicant that is under age 18.)
- I Agree
Name*
First Last
Please consider contributing to the District 36 Legislative Action Office (LAO) that supports your Right To Ride.
Please consider contributing to the District 36 International Six Days of Endruo (ISDE) fund that supports D36 riders attending the ISDE each year.
Total
$0.00
Important: Once you click the button below you will be directed to Paypal to complete the transaction. Once your online registration has been completed you will receive a confirmation email from PayPal listing your payment and what the payment is for (membership). Be sure to print this email and take with you to any events you attend as proof of your District 36 membership until you receive your membership card in the mail. (This generally takes 10-16 days).

If you are a new member to D36 or a past member renewing after one year your new membership number will be assigned when your application gets processed. If you haven’t received your card in 30 days, please contact our Membership Director at: d36memberships@gmail.com, as this receipt for your membership expires in 40 days.)
Family Member
The only eligible Family members are a spouse or domestic partner and children 17 and under all living in the same household (this family membership application will not work for two or less persons).
Primary Discipline*
Select the level ( C, B or A ) and Discipline ( Cross Country, Enduro Dirt Track or MX)
AMA Number
If a member of AMA enter AMA Number
District 36 Number
Name*
First Last
Gender*
DOB*
MM slash DD slash YYYY
Add Another
- Yes
Add Family Member
Primary Discipline*
Select the level ( C, B or A ) and Discipline ( Cross Country, Enduro, Dirt Track or MX )
AMA Number
If a member of AMA enter AMA Number
Gender*
District 36 Number
Name*
First Last
DOB*
MM slash DD slash YYYY
Add Another
- Yes
Add Family Member
Primary Discipline*
Select the level ( C, B or A ) and Discipline ( Cross Country, Enduro, Dirt Track or MX )
AMA Number
If a member of AMA enter AMA Number
District 36 Number
Name*
First Last
Gender*
DOB*
MM slash DD slash YYYY
Add Another
- Yes
Add Family Member
Primary Discipline*
Select the level ( C, B or A ) and Discipline ( Cross Country, Enduro, Dirt Track or MX )
AMA Number
If a member of AMA enter AMA Number
District 36 Number
Name*
First Last
Gender*
DOB*
MM slash DD slash YYYY
Add Another
- Yes
Add Family Member
Primary Discipline*
Select the level ( C, B or A ) and Discipline ( Cross Country, Enduro, Dirt Track or MX )
AMA Number
If a member of AMA enter AMA Number
District 36 Number
Name*
First Last
Gender*
DOB*
MM slash DD slash YYYY
Add Another
- Yes
Add Family Member
Primary Discipline*
Select the level ( C, B or A ) and Discipline ( Cross Country, Enduro, Dirt Track or MX )
AMA Number
If a member of AMA enter AMA Number
District 36 Number
Name*
First Last
Gender*
DOB*
MM slash DD slash YYYY

Membership

Family Member

Add Family Member

Add Family Member

Add Family Member

Add Family Member

Add Family Member