FAMILY MEMBERSHIP FORM - $25

Only children 17 or under may be included in Family Memberships; if you need to include more than three children, please add names and ages to the comments box on your order form.

Name
Is this a New Membership or a Renewal?
County for Membership
Best Contact Phone
Spouse's Name
1st Child's Name   Age
2nd Child's Name   Age
3rd Child's Name   Age

The Maine Motorcycle Political Action Committee (MMPAC) is our direct connection with the legislature, fighting for our rights as bikers.  The dollar indicated below does not cost you extra, but will save you in the long run because it will allow our partners funds to continue the pursuit of fairness to all motorcyclists.
Would you like $1.00 of your fee to go to MMPAC?
Can MMPAC have your mailing address?
Are you registered to vote?

If this membership is a gift, please indicate the Name of the person for whom you are purchasing this in the Name box above.