Chapter President (Circle this if applying to open a new HCMC Chapter.)
Email address to be used on web site for Chapter President:_______________________
State, County, City, City with State initials, or Military Installation name that you (Chapter
President) have chosen for your Chapter's bottom rocker.
_________________________________________
Primary......Secondary.......Associate......Nomad......Supporter
(Please circle the type of application you are submitting.)
Name_______________________________________________________
Nickname(must have one or one will be picked for you. I never use real names with photos on the
web...privacy/securityreasons.)______________________________
Date of Birth__________________________
Address_____________________________________________________
____________________________________________________________
Full time Correction Officer Yes or No
Name of Institution_____________________________________________
Employment Address___________________________________________
____________________________________________________________
Home phone #____________________Work phone #_________________
Email________________________________________________
Method of contact: (Circle one or more) home phone, work phone, email or mail.
Motorcycle Make_____________Model____________Year______
Primary member:........ employment began___________________________
Secondary Member:... employment began___________________________
Former C/O:... dates of employment________________________________
Retired C/O:... dates of employment________________________________
Associate/Nomad/Supporter member:... Sponsor's name and Chapter
____________________________________________________________
Member's relationship with Sponsor. (family member, friend, etc.)
____________________________________________________________
Submit a photocopy of your motorcycle license along with this application, and a Money Order
or check for $130.00 (USD) to Hard Chargers Motorcycle Club, HCMC or Steven Pollard. Add
$35.00 for Chapter President for a total of $165.00 (USD).
I agree to waive any and all claims against the HARD CHARGERS MOTORCYCLE
CLUB, Steven J. Pollard and its members for any accidents, injuries or losses that
may incur while a member of the HCMC. My signature confirms that I have read and agree to all
the HCMC By-Laws and will abide by them, and that I will conduct myself with honor and
respectfulness during all HCMC activities. I further statethat all information, I have provided is
true and accurate.
Applicant's signature(print and sign name)_______________________________
__________________________________Date signed___________________
Chapter President's signature of approval (print name and Chapter and sign name)
___________________________________________________________________________
_____________________________________________Date________________
Signature confirms that the above named prospect has been approved and accepted by the Chapter President
of the above named Chapter.
Potential Chapter Presidents will be approved by HCMC Home office only.
National President's signature of approval and acceptance.
________________________________________________Date_______________
HCMC Membership Application
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