Member Information Sheet

Name: B-day: / (Month/Day)

Are you a Veteran of the Armed Forces? No Yes Branch ___________________________

STAR Vet Member: Yes No

Tin Star Member: Yes No

LOS Member: Yes No

Spouse / Significant Other: ______________________________ B-day: _______/______ (Month/Day)

Children (under 18, names, ages & birthdays); Are they signed up for STAR Kids? Yes No

1. _______________________________________ 2. ________________________________________

3. _______________________________________ 4. ________________________________________

Address: _____________________________________________________________

_____________________________________________________________

_____________________________________________________________

Phone No. (Home) ____________________________ Cell No. _______________________________

Spouses Cell No. ______________________________ Fax No. _______________________________

E-Mail Address: _______________________________________________________________________

Spouses E-Mail Address: _______________________________________________________________

Bike(s) Year / Make / Model __________________/_____________________/_______________________

Ride: Single: Yes No Two Up: Yes No

Yes, I do want all of the above information published in the chapter phone book. This will include

Name, Street Address, E-Mail Address, Home Phone and Cell Phone.

Yes, I do want my information published with the following exceptions:

_______________________________________________________________________________________

_______________________________________________________________________________________

No, I do not want my information published in the chapter phone book

Comments / ride suggestions / etc: