Emergency Info Tag

Two of our Gold Members suggested 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.

A big thank you to Dawn (Wings) and Neil (Dylien), for suggesting a way we could serve our members.

The tags are free to MTF Members who have at least 50 posts and for their passenger when requested with the members tag. Replacement 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 2½" 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:

Avoid ALL CAPS. Capital letters take up more space on the tag than mixed upper-lower case, and are harder to read.
Stick with medically significant information.
Check your address carefully!
If you find an error, re-submit the request and check the box indicating that it is a resubmittal

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 Todd Graham 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 are to submit separate forms for you and your passenger.

Name
Street Address
Address (cont.)
City	State
Zip Code	Country
*E-mail Address*
*MTF ID i.e. AL2000 (1343)*
*I am a Charter 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

You can list the same contact with different phone numbers if you wish.

Emergency Contact Name #1, Relationship
*Phone #1 Number / Type*

Emergency Contact Name #2, Relationship
*Phone #1 Number / Type*

Emergency Contact Name #3, Relationship
*Phone #1 Number / Type*

Primary Physician

*Primary Physician's Name*
*Phone Number*
Medicine Allergies (Penicillin, etc.)
*Medical Conditions*
*Medical Conditions*
*Medical Conditions*
*Medical Conditions*

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.

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.

I am resubmitting the form, an error was made before

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