The items published here are in Adobe® Acrobat™ format, which must be installed on your computer PRIOR to being able to read/print these items.  If you need to install the Adobe Acrobat Reader application, please click the icon to the right of this message:

To make an Emergency Medical Information Card, follow these simple instructions below:

1. If you wish to print a BLANK form, just leave all answers blank, and click on the "Make me an Emergency Medical Information Card" button at the bottom of the page, or...
   
   

2. If you wish to fill out the form electronically, fill any of the  information requested on the form below, and then press the "Make me an Emergency Medical Information Card" button at the bottom of the page.
   
   Note that NO information is stored or collected anywhere on ANY computer.  Also, note that you do NOT have to fill out any information you do not wish to print out on the card.
   
   

3. Be patient; the processing of your data will take a few moments.
   
   When your Adobe Acrobat Reader shows you the completed form, you have the option to either save it on your local computer or to print it on your very own printer.
   
   

4. You can carry the card with your driver's license. Also you can make a backup card to carry with your motorcycle registration.

Suggestions:

• Print out a completed card and keep it in your wallet.

• Print out a another completed card and place it in a small plastic sandwich bag.

• If you have a tour pack, tape it to the underside of the tour pack lid.

• If you have saddle bags, tape it to the underside of a saddlebag lid.

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Name:
DOB:
Address:
City:
State:
Zip:
Home Phone:
Emergency Contact:
Address:
City:
State:
Zip:
Primary Emergency Phone:
Alternate Emergency Phone:
Relationship:
Medications taking now:
Allergies to medications:
Medical Conditions (diabetes, epilepsy, heart conditions, etc.):
Medical History (surgeries, traumas, heart attacks, etc. and year):
Physician's Name:
Phone:
Medical Insurance Company:
Policy Number:
Group Number:
Member Number:
Blood Type:	A+ A- B+ B- AB+ AB- O+ O-

Please pay particular attention to the printing instructions
 when the new page opens !