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| 2010/2011 Membership Application |
2010/2011 Membership Application
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FLORIDA MOUNTAINEERS SNOWMOBILE CLUB
2010-2011
MEMBERSHIP APPLICATION
NAME
ADDRESS
TELEPHONE #
YEAR; MAKE; MODEL
SERIAL NUMBER
REGISTRATION NUMBER
EMAIL ADDRESS
Single Club Membership - A single membership shall entitle that person to the voting rights outlined under the Club Charter. The cost for a single membership shall be $25.00 and all sleds registered under that membership shall be $30.00 each for the S.A.M. Trail Pass.
Family Club Membership - A Family Membership shall only be for immediate family members living in the same household and shall entitle all such members to the voting rights outlined under the Club Charter. The cost for the family membership shall be $25.00 and all sleds registered under that family membership shall be $30.00 each for the S.A.M. Trail Pass. This Family membership is only offered until December 15th. After that it is $55.00 for each sled period.
NOTE: If registering more that one (1) sled, please use the space at the back of the form for each additional machine.
REQUIRED FEES
TYPE AMOUNT DUE QUANTITY TOTAL
Single Membership $25.00 $
Family Membership $25.00 Offered only until 12/15/08 $
S.A.M. Trail Pass $30.00/per sled $
SUBTOTAL A
$
OPTIONAL FEES
TYPE AMOUNT DUE QUANTITY TOTAL
Grooming Donation 1
Trail Map (S.A.M.) $1.00/Each
Club Sticker $2.00/Each
SUBTOTAL B
$
TOTAL AMOUNT DUE (A&B)
$
I the undersigned, waive all rights from accidents, or injury, while riding on trails, or participating in any activities involving The Snowmobile Association of Massachusetts, Florida Mountaineers Snowmobile Club, any other local snowmobile clubs, private land owners, the Commonwealth of Massachusetts, or any individual townships of Massachusetts. I fully understand that the sport of snowmobiling is dangerous, involves risk of accident, or death.
Signature of Applicant: _____________________________________Date:__________
17 years of age and younger
I the undersigned as parent or legal guardian, assume the responsibilities, for the minor holding this trail permit, under the regulations of the Commonwealth of Massachusetts, and M.G.L. chapters 90-B, regulating the Use of Snowmobiles.
Signature of Parent or Guardian: ______________________________Date: __________
PLEASE MAKE ALL CHECKS OR MONEY ORDERS OUT TO: “FLORIDA MOUNTAINEERS SNOWMOBILE CLUB”
MAILING ADDRESS FLORIDA MOUNTAINEERS
C/O Mark Newman
93 park Avenue
North Adams, Ma. 01247
Upon receipt of your completed registration form, a copy of your club membership and S.A.M. sticker will be forwarded to you by mail.
If you have any questions, please contact one of the following Club Officers:
Tim Keating (413) 662-2705
Derrick Wissman (413) 664-4697
Scott Fortini (413) 663-5358
Brad Furlon (413-884-4192
ADDITIONAL SLED INFORMATION:
SLED NO 2 SLED NO 3 SLED NO 4
NAME
ADDRESS
TELEPHONE #
YEAR; MAKE; MODEL
SERIAL NUMBER
REGISTATION NUMBER
EMAIL ADDRESS
Created on 10/08/2008 08:52 AM by timkeating
Updated on 08/31/2010 10:41 AM by timkeating
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