Emergency Info Tag


Cyclegadgets.com offers Free Emergency Tags to their customers. Two of our Gold Members suggested that we make a card for MTF Members that could be used as both an Emergency tag and a Name Tag at MTF events. I think the idea spawned in one of the chat sessions, see what you are missing by skipping chat. Not only did Neil and Dawn make the suggestions; but, in true MTF Fashion, they have agreed to manage the program. We have received permission from Cyclegadgets.com to use the information from their website as a basis for the project. Cyclegadgets.com has also agreed to selling the blank tags at their cost, so we would encourage you to support them.


Thank you Dawn (Wings) and Neil (Dylien), both for suggesting a way that we could serve our members.


The MTF will provide one free tag per year to members who have at least 50 posts, and for their passenger when requested with the members tag.   Additional tags may be purchased for $5.00 each.

Accidents happen. We don't like to think it will happen to us, or that we might be injured, but it's best to be prepared. In the unfortunate event that you are involved in a motorcycle accident a waterproof and colorful tag to attract the attention of emergency personnel could save a life

          

The MTF Emergency Info Tag is approximately 2" x 4", laminated, and can be easily attached to a zipper or placed in an accessible pocket.  It contains pertinent information about you on one side, emergency contacts on the other, and is designed to be noticed.  

Please fill out the following information as accurately and completely as possible to order your Emergency Info Tag.  Information in Bold is required to provide your tag.

Some important tips for entering your information:

Note: In appreciation of your privacy, Emergency information will only be kept for two weeks from the date the tags are mailed. You will receive an email notification when we mail the tag. If the tag is not received for any reason contact us at: Emergency Tags within that two week period, a new tag will be mailed out using the previously submitted information under our free tag program. A request for a new tag after the more than two weeks after the tag is mailed  or a request for a tag with new information will be considered a replacement tag and will need to be resubmitted and will be assessed the replacement tag fee.


Personal Identification

You must submit separate forms for you and your passenger.
Name
Street Address
Address (cont)
City    State  
Zip Code Country  
Email Address
Note: A copy of this form will be sent to this email address for your records.
MTF ID i.e. AL2000 (1343)
 
I am a Charter Member, please use special logo
I am a MTF Volunteer Staff Member, please use special logo
I am a Gold Member, please use special logo
I am a MTF Tourers Assistant, please use special logo
This tag is for my passenger (must be submitted on same date as member request)
This is a replacement/extra tag. I understand there is a $5.00 charge. You will be provided payment options when you submit this form.

Card Information

(Please don't put carriage returns in these fields - we will format the text when we print the tags. Separate lists with commas or semicolons and spaces.)

Emergency Contacts

Emergency Contact Name #1,
Relationship
Phone #1 Number    Type of phone
Emergency Contact Name #2,
Relationship
Phone #2 Number    Type of phone
Emergency Contact Name #3,
Relationship
Phone #3 Number    Type of phone

Primary Physician

Physician
PhysicianPhone
Medicine Allergies
(Penicillin, etc.)
Medical Conditions
Medical Conditions
Medical Conditions
Medical Conditions

Medical Insurance Information

Insurance Company
Policy / Group #
Additional Information
Additional Information
Additional Information
Additional Information

Bike Information

Optional

Comments

Our form may not cover all situations. If you had problems with the allotted space or have other comments that you would like to
make to the Emergency Tag Staff, use the box below.
Comment:

Click "Submit Form" to request your MTF Emergency Info Tag. 
Please review the information carefully before submitting your request. 
Please allow up to 6 weeks for processing. If you have any problems, post a message on the forum and we will try to resolve it asap.