Membership Registration Form

To show your support for VCOM, complete the information below and select your level of membership. You will then be taken to a payment page. Use your credit card with Pay Pal or mail your check to VCOM 1509 W. Cary St., Richmond, VA 23220

Basic Membership- $25 You receive a VCOM pin, patch, and bumper sticker.

Freedom Fighter – a contribution above the Basic Membership.

Would you like to support VCOM every year by setting up annual recurring payments* or make a one-time contribution to VCOM?

* Annual recurring payments can be cancelled at any time.

Membership Form - One-Time Contribution

Name*
First Last
Address*
Street Address City State ZIP Code
Phone
Email*
Occupation*
Employer*

*Required for donations over $100
Club Memberships
Type of Motorcycles Owned
Are you a Registered Voter?
- Yes
- No
District - House
District - Senate
What issues are you most interested in seeing VCOM address?
Donation Amount*
Other
Total
$0.00
Business Name
Business Address
Street Address Address Line 2 City State ZIP Code
Business Phone
Business Website
Payment Method

MasterCard
Visa
Supported Credit Cards: MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name

Membership Form - Recurring Payments

Name*
First Last
Address*
Street Address City State ZIP Code
Phone
Email*
Occupation*
Employer*

*Required for donations over $100
Club Memberships
Type of Motorcycles Owned
Are you a Registered Voter?
- Yes
- No
District - House
District - Senate
What issues are you most interested in seeing VCOM address?
Membership Level*
Other

per year
Total
$0.00
Business Name
Business Address
Street Address Address Line 2 City State ZIP Code
Business Phone
Business Website
Payment Method

MasterCard
Visa
Supported Credit Cards: MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name