Membership Form

19 November 2018 Last Updated: 19 November 2018

Membership Registration Form

If you have been convicted of felony crime against children or involving domestic violence, please go no further.

Change of Email Address:

Send an email containing your old email address and the new email address to: This email address is being protected from spambots. You need JavaScript enabled to view it.

Confirmation Process

Once you have completed this form, you will receive an email asking you to confirm your membership registration. Please be sure to check your Spam/Junk email folder for this confirmation request and follow the directions. Please add us to your safe list to receive future emails.

All data is kept confidential and will not be shared, sold or distributed.

IMPORTANT EMAIL ADDRESS RESTRICTIONS

1 - If you have any type of ROADRUNNER (*rr.com), you must use a different email provider to receive our Mission emails. Spectrum/Charter Communications system will NOT forward our emails to those types of email addresses.

2 - If you have any type of OPTIMUM (*optonline.net), you must use a different email provider to receive our Mission emails. Optimum will NOT forward our emails to those types of email addresses.

Our recommendations is to set up an email account with free email providers such as: Gmail, Yahoo, etc.

These email address restrictions are in place until further notice.

Date Choose date from calendar

Title:

First Name:

Middle Initial:

Last Name:

Address 1:

Address 2:

City:

State Please use 2 digit state abbreviation.

Zip Code:

Choose your Region based on the County you live in.

You MUST choose a Region and only one region.

Please choose Region number that is associated with the county you live in. If you wish to receive Mission emails from other Regions, you will need to fill out a Membership form for each Region individually.

Region - County List

Region 1 includes: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Livingston, Niagara, Orleans, Wyoming

Region 2 includes: Broome, Cayuga, Chemung, Chenango, Cortland, Monroe, Ontario, Schuyler, Seneca, Steuben, Tioga, Tompkins, Wayne, Yates

Region 3 includes: Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St Lawrence

Region 4 includes: Clinton, Essex, Franklin, Fulton, Hamilton, Saratoga, Warren, Washington

Region 5 includes: Albany, Columbia, Delaware, Greene, Montgomery, Otsego, Rensselaer, Schenectady, Schoharie

Region 6 includes: Dutchess, Orange, Rockland, Sullivan, Ulster

Region 7 includes: Bronx, Putnam, Westchester

Region 8 includes: Kings (Brooklyn,) New York (Manhattan,) Nassau, Queens, Richmond (Staten Island)

Region 9 includes: Suffolk

Phone Number: Input phone number formatted as numbers only. Do not input dashes.

Email Address:

Confirm Email Address Email addresses must match.

How did you hear about Patriot Guard Riders: Please do not exceed 100 characters

Comments Please do not exceed 255 characters

Please note:

By submitting this form, you agree to receive e-mail updates about PGRNY events in your area. After submitting this form, you will receive an e-mail from our mail server with the subject: "confirm".

Check your spam folder for this message if you do not see it in your inbox.

You must follow the directions in that e-mail to confirm your subscription to be added to the mailing list for your region.

If you have difficulty subscribing, you may e-mail This email address is being protected from spambots. You need JavaScript enabled to view it.

Please do not use this form to change your email or suspend email mission notifications. Please contact This email address is being protected from spambots. You need JavaScript enabled to view it.