CENTRAL ILLINOIS A.B.A.T.E. /A.B.A.T.E. of ILLINOIS MEMBERSHIP APPLICATION

New Member (1) _______ (2) _______ Renewal (1) _______ (2) _______ Card # (1) _______ (2) _______
Date __________ Date Joined (if renewal) (1)_______ (2)__________ Chapter Preference _Central IL A.B.A.T.E.
Name (1)____________________________ (2) _____________________________________
Address _____________________________________________________________________
City ___________________________State__________ Zip _________
Phone ( )_____________ County_______________
Registered Voter (1)__________ (2) ___________
Congressional District_________ Senatorial District_______ Representative District_________
Date of Birth (1)_____________ (2)_____________
Occupation (1)___________________ (2) ______________________
Completed an MSF Course (1)____ (2)______
Where did you hear about A.B.A.T.E. _________________________
$2.00 of each member's dues is allocated to lobbying expenses and $1.00 is donated to the Motorcycle Riders Foundation (MRF)
MAKE CHECK PAYABLE TO ABATE AND MAIL TO:

Central Illinois A.B.A.T.E. PO Box 1084 * GALESBURG, ILLINOIS 61402-1084


* MUST BE 18 TO JOIN* 309-343-6588 800-87-ABATE FAX 309-343-6387
I understand that Central IL ABATE & ABATE of Illinois cannot assume responsibility for my safety and that if I participate in any sanctioned event, I do so voluntarily, assuming all risk: I release and hold ABATE harmless for any injury or loss of my personal property which may result there from. I understand this means that I agree not to sue ABATE for any injury resulting to myself or my property at any event. I agree to comply with the bylaws and act in the best interest of Central IL ABATE & ABATE of Illinois. A copy of the ABATE-PAC’s report is or will be filed with the State Board of Elections, Springfield, Illinois.

Signature (s) (1)___________________________________________ (2)_____________________________________________

MEMBERSHIP & RENEWAL FEE ! $25.00 PER YEAR SINGLE ! $45.00 PER YEAR COUPLE
MONEY SAVER SPECIAL ! $100.00 – 5 YEAR SINGLE ! $180.00 5 – YEAR COUPLE
ABATE-PAC SUPPORT ! Add $1.00 per year to above dues amount to support legislative contributions.
Please allow 4-6 weeks for processing