Road 2 Recovery International Membership Application
This Order Form is Secure
Personal Information
First Name MI
Last Name
Address
City
State/Province
Country
Zip/Postal Code
Email
Home Phone
Cell Phone
Gender Male Female
Date of Birth format dd/mm/yyyy

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Membership Options
1 Year Membership- $25
Pro MX/SX Rider membership 1 Year – $35
Pro MX/SX Rider Founding membership Lifetime - $1000
 
Credit Card Information
 Card Type
 Name on Card
 Card Number
 Expiration Date
 CVV Number (3 or 4 digit security code)
Your new membership card will be mailed in 3-4 weeks. Thanks for supporting the Road 2 Recovery, a 501(c)(3) non-profit organization dedicated to helping FIM licensed  MX1, MX2, MX3 members with financial assistance if they sustain career-ending injuries, as well as providing motivational, emotional, and spiritual support to the individuals and their families.
The Road 2 Recovery Foundation is recognized by the U.S. Government as a not-for-profit charity foundation that meets the 501c-3 requirements.
Our charitable tax ID number is: 86-0996104