MJM Membership Application & Renewal Form

Please Print Form Here

Motorcyclists for Jesus Ministries

MJM Membership Application & Renewal Form

Motorcyclists for Jesus Ministries - is a ONE back patch organization.

OUR BACK PATCH IS NOT TO BE ADDED TO IN ANY WAY SHAPE OR FORM.

I.E. Identifying rockers, territory, T.E.A.M. names, etc. cannot be worn on the back of a members vest or jacket. Please print form and mail to:

MEMBERSHIP APPLICATION     /         RENEWAL FORM

Check Box that applies [  ]                                                                                [  ]

Name______________________________________________________     Date of Birth ___________

I’m/ We are born again Christian/s                   Check Box for Yes                    [   ]

Spouse______________________________________________________  Date of Birth ___________

( The definition of a Biblical couple, Constitutes one Man legally Married to one Woman )

Anniversary Date:         __________

Street Address: ____________________________________________________________

City: _________________________________ State: ____________ Zip: ____________

Applicants Day Phone: (____)_______________________                                               Fax: _______________________

Spouses Day Phone: (____)________________              Spouses Fax: _____________________

Applicants E-Mail: ________________________________                       Spouses E-Mail: ___________________________

Applicants Signature: ________________________________________

Spouses Signature: __________________________________________

Church Affiliation: _________________________________

MJM TEAM Member: _________________________________

Other Club Affiliation [s]: __________________________________________________________

Use the back for extra space to list all Clubs