OILHEADSCLUB.ORG -> Membership Change

Membership Application

Membership Rates
U.S. Resident	$15.00 US
Canadian Resident	$20.00 US
Residents of Other Countries	$30.00 US
Associate Membership *	$5.00 US
Notes: * Due to the increase in the International Postal Rates, we have been forced to increase membership dues. ** An Associate member must reside at the same address as the regular member, does not receive club mailings, but does have full voting privileges if over 16 years of age.

Instructions:

Please fill out the form below.
Fields marked with an * are required.
Once you submit the form, you need to print the confirmation page which will contain your member information.
Send the printed page to:
    Oilheads Club
    P.O. Box 8081
    Charlottesville, VA 22906-8081

Application for:

Change of Address

Membership Type:*

Regular Associate

Member Name:*

Member Nickname:

Associate Name:
(if applicable)

Associate Nickname:
(if applicable)

Email:*

Street Address:*

City:*

State:*

Zip Code:*

Country:*

Home Phone:*

Work Phone:

Please tell us about the bikes you ride:

I would be interested in helping with the following activities:

Newsletter
Rallies
Rides
Social
Technical
Web Page
Other

Please include any comments or suggestions you may wish to share: