MEMBERSHIP APPLICATION

To join the Motorcyclists for Jesus Ministry, please 
print form and mail to:
Motorcyclists for Jesus Ministries
4560 Lecta Kino Road
Glasgow, KY 42141
270-678-2229            FAX 270-678-5870

Annual Dues:  $15.00 Single [US]/ $25.00 [US] Couple

$35.00[US] outside the US for single and $45.00[US] per couple per year

Lifetime Membership:  $200.00 [US] Single
                                          $300.00 [US] Couple

 

Name______________________________________________________

Check here if your a born again Christian [ ]

Church Affiliation_____________________________________

Day Phone  (____)______________    Fax: ________________

E-Mail ________________________________

Age _________        Date of Birth _________________

Signature _____________________________

 

Spouse______________________________________________________

Check here if your a born again Christian [ ]

Church Affiliation_____________________________________

Day Phone  (____)______________    Fax: ________________

E-Mail ________________________________

Age ______  Date of Birth __________  Anniversary ________ 

Signature _____________________________

Street Address_______________________________________
 _____________________________________________________

City__________________________________________________________

State____________ Zip____________________

Motorcycle Club Affiliation [s] ___________________________

 ___________________________________________________

 

 

 

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E-Mail: mjm@pagospelriders.com