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.
Name _________________________________________________________________________________________ Age ____________
Address __________________________________________________________________________________________________________
City _______________________________________________________ St. __________ Zip _____________________________________
Phone (___________)________________________________ Shirt Size ___________________
E-Mail address___________________________________________________________________________________________________
Cycle Description _________________________________________________________________________________________________
12 months USA Membership - *$40 12 months International Membership - *$75 (Note: Mailings limited to one attempt.)
Disclaimer:
I understand that FSSNOC, INC. and/or Director Jack Robinson cannot assume responsibility for any aspect of my safety or sanity 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 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____________________________________________________________________
(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.
Name _________________________________________________________________________________________ Age ____________
Address __________________________________________________________________________________________________________
City _______________________________________________________ St. __________ Zip _____________________________________
Phone (___________)________________________________ Shirt Size ___________________
E-Mail address___________________________________________________________________________________________________
Cycle Description _________________________________________________________________________________________________
12 months USA Membership - *$40 12 months International Membership - *$75 (Note: Mailings limited to one attempt.)
Disclaimer:
I understand that FSSNOC, INC. and/or Director Jack Robinson cannot assume responsibility for any aspect of my safety or sanity 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 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____________________________________________________________________