Name: ________________________________ Date: __________
Address:_______________________________________________
City/Town:______________________________________________
State:________________________ Zip Code:_________________
Phone: (__________)_____________________________________
Family Members: ________________ ATVs in Family: _________
List Family Members: (husband, wife and any dependents under 18.)
Name:_____________________________ Age: _______
Name: _____________________________ Age: _______
Name: _____________________________ Age: _______
Name: _____________________________ Age: _______
Name: _____________________________ Age: _______
Name: _____________________________ Age: _______
Dues$20.00, ($25.00, Canadian), make checks payable to Borderline ATV Club. Membership includes membership card, newsletter and one sticker that will be mailed with next newsletter or can be picked up at next meeting.
Mail payment and signed form to: BORDERLINE ATV CLUB, 1574 Van Buren Road, Caswell Maine 04750
Email: lzenzius@maine.rr.com
Website: www.borderlineatvclub.homestead.com
The undersigned agrees to abide by all club rules, regulations and state laws pertaining to ATVs.
Signed: _______________________________________________
