PACKERLAND HOG CHAPTERMember Nat'l H.O.G. Number: Zip: Expiration Date of National H.O.G.@...

Post on 27-Sep-2020

3 views 0 download

Transcript of PACKERLAND HOG CHAPTERMember Nat'l H.O.G. Number: Zip: Expiration Date of National H.O.G.@...

PACKERLAND HOG CHAPTERLocal Chapter Information

New q Renewal q

$10.00 Membership FeePlease complete form below for Local Chapter use:

Name:

DOB: Wedding Anniversary: ( )

E-Mail Address:

Mail to: Vandervest Harley-Davidson of Green Bay, ATTN: Kay Kozlowski, Membership. 1966 Velp Ave., Green Bay, WI 54303. 920-498-8822.

CHAPTER USE ONLY: Application Denied ____ . Application Approved ____.