GAME CHANGER CLUB PHILIPPINES

Membership Form

Name: ______________________________________________ Membership Serial No. _________

Address: __________________________________________________________________________

Birth date: __________________ Age: ______ Gender: _______ Birth place: ___________________

Telephone No: _____________________________ Mobile No: ______________________________

Email address: ________________________ Facebook Account: _____________________________

T-Shirt Size: S__ M__ L__ XL__ XXL__ XXXL__ Other ______

Vest Size: S__ M__ L__ XL__ XXL__ XXXL__ Vest Name: __________________

Motorcycle Type/ Model: ________________________ Plate Number: ________________________

OR/CR: ______________________________ License No: ___________________________________

SSS No: ______________________________ PhilHealth No: ________________________________

In case of emergency please contact: __________________________ Relationship: ______________

Address: ____________________________________________ Number: ______________________

Rules and Regulations:

In order to proceed, you must agree with the following rules and regulations.

1. Game Changer Club Philippines do not endorse any kind of stunts or unlawful behavior on
roads and always promotes road safety.
2. At least 18 years old, helmets and protection gears are required on both riders and back
riders.
3. We required all officers, members and back riders to strictly follow the rules.
4. Always observe our chain of command, respect each other.

Declaration:

I declare that the above information’s are true and correct to the best of my knowledge and
belief. In addition, I have to agree to the rules, terms and conditions and agree to comply.

Date: _______________________

Place: _______________________

______________________________________
Signature over printed name