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PACKERLAND HOG CHAPTERMember Nat'l H.O.G. Number: Zip: Expiration Date of National H.O.G.@...

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Page 1: PACKERLAND HOG CHAPTERMember Nat'l H.O.G. Number: Zip: Expiration Date of National H.O.G.@ Membership: I have read the Annual Charter for H.O.G.@ Chapters and hereby agree to abide
Page 2: PACKERLAND HOG CHAPTERMember Nat'l H.O.G. Number: Zip: Expiration Date of National H.O.G.@ Membership: I have read the Annual Charter for H.O.G.@ Chapters and hereby agree to abide

PACKERLAND HOG CHAPTERLocal Chapter Information

New q Renewal q

$10.00 Membership FeePlease complete form below for Local Chapter use:

Name:

DOB: Wedding Anniversary: ( )

E-Mail Address:

Mail to: Vandervest Harley-Davidson of Green Bay, ATTN: Kay Kozlowski, Membership. 1966 Velp Ave., Green Bay, WI 54303. 920-498-8822.

CHAPTER USE ONLY: Application Denied ____ . Application Approved ____.


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