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.   I am a rider.                                     Enter Promo Code, if available.       Promo Code: I am a motorcycle/scooter dealer or repair shop.       Dealer ID: Type in your Dealer ID.       Order Type: Over-the-counter sale Embedded  (Must be free to customer)         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 / Scooter Upgrade   Year -- Select -- 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 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