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IN CASE OF
EMERGENCY
Print this handy form and fill
it out. Place it in a safe place on your bike
(In a stash tube, fork bag, etc.), so authorities
can find it easily in case of an emergency.
VITAL INFORMATION:
| Name
(First and Last): |
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| Town: |
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| State: |
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| Country: |
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| Birth Month: |
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Birth Year: |
License State and No.: |
| Organ Donor: |
Yes
No |
| Primary Language: |
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CONTACT INFORMATION:
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Contact
person |
Telephone
Number |
Type |
Relationship |
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COMMENTS:
You
can use this area to list any medical information you think
emergency personnel should know, and possible who your doctor is and
what hospital you prefer.
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OTHER INSTRUCTIONS:
You
can use this area to specify where you'd like your bike taken, and
by whom.
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This printable form
provided by bykrmom, and the members of ChopperFix.com
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