VJEMC - Membership application

You may print out this page to submit your membership application to the VJEMC.

1 year membership=$15 _______

2 year membership=$28 _______

Note: All payments must be made in U.S. Funds

Same price for anyone from any country!!

Name: ________________________

Street: __________________________

City: ____________________________

State: ___________________________

Country: _________________________

Zip Code: _______________

Phone: __________________________

Email: ___________________________

I was referred for a VJEMC membership by _____________________________

Motorcycles in your collection or on your want list:

________________________________________________

________________________________________________

Would you be interested in being an VJEMC field representative in your area?
YES NO MAYBE

Mail completed form to:

VJEMC
4492B Annabell Circle
Green Bay, WI 54313