Long Island ABATE

<%@ Master language="C#" %> Long Island ABATE

Promoting Motorcycle Safety, Awareness, & Education

Mailing Address:
Long Island ABATE
P.O. Box 22
Yaphank, NY 11980

Our Hotline Number
1-(888)-LIABATE

ABATE MEMBERSHIP FORM

MAIL TO : LONG ISLAND ABATE
ATTN: MEMBERSHIP
P.O. BOX 22,
YAPHANK, N.Y. 11980

Full Member: $25.00 Per Year - Includes Membership Patch, Newsletter And All Benefits In Accordance With State By-Laws.

Associate Member: $20.00 Per Year - Same Benefits, Except No Newsletter, This Is Available Only To Additional Members Of Full Members Households.

First name

Last name

County of residence

Street address

City

State

Zip code

Primary phone number

Secondary phone number (not required)

Date of birth

Pay by Credit Card

Card Type Number
CV2 Expiration Date

Exact Name on Card:
Signature Date

How many years have you been riding a motorcycle? (not required)

Have you taken a motorcycle safety course? Yes No (not required)
If yes, How many years ago
Signature Date

Keep me informed! Please contact me with the email address that I'd supplied to Long Island ABATE so I can receive current information about Runs, Schedule Changes or Upcoming Events.

By checking this box, I agree to comply with ABATE of New York's by-laws, and promote motorcycle education, legislation, and activities in accordance with ABATE of New York.