C/o Red Knights Vermont Chapter II
Post office Box 2518
West Brattleboro, VT 05303

Name: ______________________________ Phone: ________________________
Address: ____________________________ E-mail: _________________________
Town: ______________________________ State: ________ Zip: _____________

Fire Department Affiliation: ___________________________________________________________

Have you ever been convicted of a crime? __________________________________

From the Chief or an Officer of the Department:
I certify that the above named individual is an active/retired member in good standing with the ______________________________ Fire Department at the present time.

Chief or an Officer of the Department: ___________________________________

Sponsoring Member of Vermont II: ______________________________________

Application Fee: Five ($5) dollars (non-refundable) Plus Twenty ($20) dollars per year. Please make all checks payable to Red Knights Vermont Chapter II.

I understand I must abide by all rules and by-laws of Vermont Chapter II and The Red Knights International Motorcycle Club. Failure to do so will result in the termination of my membership with Red Knights Vermont Chapter II.

Signature of Applicant: ___________________________ Date: _____________

Membership committee only: After investigation of the above named individual, we, the membership committee recommend / reject approval of this applicant for membership.

Member Status: Active Associate Social Retired Special Honorary Member
Membership Number: ____________

Committee Representative: _____________________________ Date: _________

Complete and mail to address shown on application
or bring it with you to our next meeting.
Thank you.