Buffalo Soldiers of Jackson, Tennessee Membership Form Name (Include middle initial) Your chosen biker name:: Street Address:: City/State/Zip Code:: Home Phone#: Cell Phone #: Business Phone#: Age:: E-Mail Address:: Emergency Contact:: Relationship: Emergency Contact Phone #: Are you legally licensed to operate a motorcycle?: Do you currently own a motorcycle?: If yes, Type, Model, Year, CC's: # of years riding experience: Please give a brief history of yourself (including military service, current employment, and membership in any other motorcycle clubs. Explain why you are interested in becoming a member of the Buffalo Soldiers Motorcycle Club of Jackson, Tn: I fully understand that the chapter colors purchased by me are the property of the NABSMC and must be returned to the chapter upon my departure regardless of reason:: Signature:: Date::