Membership Application Form

STAR Touring & Riding Membership Application

Please Note:  This is an official registration form.  All information is submitted directly to Yamaha Corporation and is confidential and secure.

Before becoming a member of L.I. STAR Chapter 278, you must register and become a STAR National Member first.

Subscription Type: New Renewal Add family to existing membership      *
NOTE: Items marked with an asterisk (*) must be completed or application CANNOT be submitted
First Name* Middle Last Name* Email Address*
Mailing Address* Home Phone* (xxx-xxx-xxxx) Work Phone
City* State* Zip*                     Country Fax
   
NEW MEMBERS select type of patch desired: STAR Patch LOS Patch
FAMILY MEMBERSHIP INFORMATION
Spouse Name (Please include middle initial) Significant Other Name (Please include middle initial)
OR Select One Patch:
  (Must live in same household) STAR Patch
STAR KiDs:   LOS Patch
  • Up to 15 Children or Grandchildren under the age of 18 may join Star under one membership.
  • The first four children or grandchildren are FREE.
  • A charge of $10 per child will be charged for 5 or more children or grandchildren.
Full Name of Child/Grandchild   Date of Birth Full Name of Child/Grandchild   Date of Birth
(Please include middle initial)   (mm/dd/yyyy) (Please include middle initial)   (mm/dd/yyyy)
*     *   
* *
* *
* *
* *
* *
* *
* Total of Children/Grandchildren:   
Find a chapter near me!
Type of Motorcycle:(Check all that apply, including those for Family Membership)
Star Venture Road Star Wild Star VStar 650 Drag Star
Royal Star Road Star Warrior VStar 1100 Drag Star 1100 Other (Please specify)
  
Membership Cost:
Addt'l Star Kids Cost:
TOTAL CHARGE:
Credit Card Information:
Your Name on Credit Card:*
Visa MC Discover (U.S. Funds ONLY)
Credit Card #*
Expiration Date:* (mm/yy)

Additional Comments: (Less than 300 characters)