MEMBERSHIP APPLICATION FOR THE FOUR-STROKE SINGLES NATIONAL OWNERS CLUB
(FSSNOC)
Print or duplicate and complete this form. Mail to:
FSSNOC, INC.
P.O. Box 1809
Hutchinson, Kansas 67504-1809
*Checks and money orders must be in U.S. funds and drawn upon a US bank payable to: FSSNOC, INC.
*All applicants must supply the club with a USA mailing address. We no longer mail to Out-of-USA addresses.
Name _________________________________________________________________________________________ Age ____________
Address __________________________________________________________________________________________________________
City _______________________________________________________ St. __________ Zip _____________________________________
Cell Phone ______________________________________ Shirt Size (circle) Med - Large - X-Large - XX Large.
Be sure to indicate your shirt size! Members receive a FREE club t-shirt with each annual membership, limited to one attempted mailing.
E-Mail address___________________________________________________________________________________________________
Cycle Description _________________________________________________________________________________________________
12 months Membership to a USA address - $100.00
(Note: potential members must supply the club a USA mailing address.)
Disclaimer:
I understand that FSSNOC, INC. and/or Director Jack Robinson cannot assume responsibility for any aspect of my safety or sanity or health before, during, or after I have read Thumper News, visited the club website, or have associated with a FSSNOC
member or staff. I also understand that should I participate in any member gathering, I do so voluntarily on my own
assessment of facilities and conditions, assuming all risk; and I hereby release and hold FSSNOC, INC. and FSSNOC
Director Jack Robinson harmless for any injury or personal grievance or loss to my person or property or for any health issue which may result therefrom. I also understand that FSSNOC,INC. does not offer or maintain any insurances for my behalf.
I hereby certify that I have read and understand this disclaimer by my signature below:
Signature Required: X______________________________________________________________ Date:________________________
(FSSNOC)
Print or duplicate and complete this form. Mail to:
FSSNOC, INC.
P.O. Box 1809
Hutchinson, Kansas 67504-1809
*Checks and money orders must be in U.S. funds and drawn upon a US bank payable to: FSSNOC, INC.
*All applicants must supply the club with a USA mailing address. We no longer mail to Out-of-USA addresses.
Name _________________________________________________________________________________________ Age ____________
Address __________________________________________________________________________________________________________
City _______________________________________________________ St. __________ Zip _____________________________________
Cell Phone ______________________________________ Shirt Size (circle) Med - Large - X-Large - XX Large.
Be sure to indicate your shirt size! Members receive a FREE club t-shirt with each annual membership, limited to one attempted mailing.
E-Mail address___________________________________________________________________________________________________
Cycle Description _________________________________________________________________________________________________
12 months Membership to a USA address - $100.00
(Note: potential members must supply the club a USA mailing address.)
Disclaimer:
I understand that FSSNOC, INC. and/or Director Jack Robinson cannot assume responsibility for any aspect of my safety or sanity or health before, during, or after I have read Thumper News, visited the club website, or have associated with a FSSNOC
member or staff. I also understand that should I participate in any member gathering, I do so voluntarily on my own
assessment of facilities and conditions, assuming all risk; and I hereby release and hold FSSNOC, INC. and FSSNOC
Director Jack Robinson harmless for any injury or personal grievance or loss to my person or property or for any health issue which may result therefrom. I also understand that FSSNOC,INC. does not offer or maintain any insurances for my behalf.
I hereby certify that I have read and understand this disclaimer by my signature below:
Signature Required: X______________________________________________________________ Date:________________________