____Membership Renewal                                            

                Card #_________________________    ($25)

____New Membership                                                    ($25)

____Associate Membership (18 yrs and younger)    

                Sponsor Card Number_____________   ($10)

____Supporting Business                                              ($50)

____Lifetime Membership                                            ($400)

Amount Enclosed (Check/Money Order Only) $_____

Date___________ 

Name_______________________________________

Address_____________________________________

City/State/Zip________________________________

Phone_______________________________________

Email Address________________________________

  0  Check this box if you DO NOT want $5 to go to the ABATE Pac Fund

___I am a registered voter in Nebraska

___I am an endorsed Motorcyclist in Nebraska or any other state

___I have taken a motorcycle safety or riders education course

I understand by signing my name to this application, I am seeking membership into a motorcycle rights organization.

Discloser: Contributions to the ABATE of Nebraska PAC Fund are NOT deductible as charitable contributions for federal income tax purposes.

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Signed______________________________________

Legislative District____________________________

Recruited by: ________________________________