The Venturers M/C

The Venturers
Membership Application

INSTRUCTIONS

This form is for mailed payments only. To pay with PayPal, click here
Fill out the form, with all requested data. Those marked with * are required.
Once the form has been filled out, Press the print button in your browser to make a copy of the form.
Click on "Submit Application" at the end of the application.

PERSONAL INFORMATION

	Member	Associate
* First & MI
* Last
BirthDate (MM/DD/YYYY)

ADDRESS INFORMATION

* Street or PO Box	* City
* State/Province	* Zip Code
Country	* E-Mail Address

TELEPHONE

Day: Night: Cell:

* SELECT DESIRED MEMBERSHIP

New Membership

Renewal Membership

* Forum Username:

1 Yr Membership = $20.00	1 Yr + Associate Membership = $25.00
2 Yr Membership = $35.00	2 Yr + Associate Membership = $40.00
3 Yr Membership = $50.00	3 Yr + Associate Membership = $55.00

All funds in US Dollars

* METHOD OF PAYMENT

Please check your method of payment:
Personal check
Money Order

Please make Checks/Money Orders payable to:

The Venturers Inc.

Mail your checks/money orders and a copy of this application to:

Brent Evans - Treasurer
The Venturers, Inc.
7801 Cedar Ridge Dr.
Pickerington, OH 43147

If you need to contact the Membership Coordinator, send an E-Mail to memberships@venturers.org

Before you press the Submit button, double-check your information to make sure everything has been completed.
Make sure to print a copy of your completed form. You may wish to print one for your records also.

One of the printed copies must be mailed to the Treasurer with your payment.