NAME______________________________________________________RENEWAL / NEW
ADDRESS____________________________________________________________________
CITY/TOWN__________________________________________ STATE_____ ZIP__________
EMAIL______________________________________________________________________
NUMBER OF FAMILY MEMBERS_______ TELEPHONE_____________________________
NAMES OF FAMILY MEMBERS_________________________________________________
INDIVIDUAL / FAMILY $20.00__________BUSINESS $35.00______________
PAYMENT IS DUE WITH APPLICATION PLEASE MAKE CHECK PAYABLE TO:
CENTRAL MAINE ATV CLUB PO Box 303 FAIRFIELD, ME 04937
***membership fee is due by July 1, 2010***
DATE PAID_______________________ CASH / CHECK