| First Name (PRINT ONLY): |
__________________________________________________ |
| Last Name: |
__________________________________________________ |
| Street Address/PO Box: |
__________________________________________________ |
| City: |
__________________________________________________ |
| State: |
__________________ |
Zip Code: |
________________________ |
| |
| Family Membership Information |
|
Spouse: |
First Name |
___________________ |
Last Name |
_____________________ |
| Children under 18 that intend to register a
sled: |
|
_____________________________________________________________________________________ |
| |
| Phone #:
__________________________________ |
| Email address:
____________________@______________________________________ |
| (DMV Voucher, NYSSA News letter and other
information can be emailed) |
| |
| ( ) |
Club Membership $30.00 |
| ( ) |
NYSSA Trail Defender membership upgrade additional
$20.00 |
|
| |
| Have you already paid NYSSA Dues this season via
another club?
(circle one) |
YES |
NO |
| If so, which Club:
_______________________________________________ |
|
|
|
| |
| Twenty five cents of your $5 NYSSA dues will
be used for the NYS Snowmobile PAC (Political Action Committe) who is our
voice in Albany. If you do not wish to contribute to the NYS
Snowmobile PAC, please check this box. [ ]
Please note, your NYSSA dues remain $5.00 |
| |
| |
|
__________________________________________________________________________________________________ |
|
For Club use only |
| Blank Voucher
ID issues (ex 07-140-B183): ___________________________ |
| Snowmobile
Trail Landowner [ ] |
| EMBED 3/4 |