Rider's Membership Application

Remember – you are covered wherever you ride in Canada and Continental U.S.A.

To sign up for the MotoRescue Membership Card, please fill out the form and click the Send button below. Coverage begins as soon as you receive your MotoRescue Membership Card (within 5-7 business days following registration).

Fields marked with an are required. New Membership    Renewal   (Enter Membership No. below)   Membership No. or Promo Code: Enter Membership No. or Promo Code, if available.   I am a Dealer, or I have my obtained my new membership card from my club or association and I need to activate the card. (Enter Membership No. above)         RIDER'S PERSONAL INFO       Name Street Address City Province -- Select -- ALBERTA BRITISH COLUMBIA MANITOBA NEWFOUNDLAND NEW BRUNSWICK NORTHWEST TERRITORIES NUNAVUT NOVA SCOTIA ONTARIO PRINCE EDWARD ISLAND QUEBEC SASKATCHEWAN YUKON Postal Code Country Canada Telephone  Include area code Email     Privacy Policy         VEHICLE TO BE COVERED Vehicle Type Scooter Motorcycle   Year Make Model License Plate No. Use last 8 digits of VIN if no plate available. Colour Colour(s) of vehicle.         A M O U N T Rider's Price $ Tax $ HST Total $ All prices in Canadian Dollars