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Membership
Application 2007-2008 |
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Northern Warren
Trailblazers |
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P.O. Box 613 |
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Chestertown, NY 12817 |
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email:
nwtrailblazers@aol.com |
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website:
northernwarrentrailblazers.snowclubs.com |
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Snow Phone 518-494-0113 |
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| First
Name (print only): _____________________________ Last
Name:__________--_____________________ |
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| Address:__________________________________________
City:_____________________________________ |
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| State:____________________________
Zip Code:_________________ County:_________________________ |
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| Phone
number:________________________ email
address:_________________________________________ |
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| Family
membership information |
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| Spouse
First Name:_________________________________ Last
Name:_______________________________ |
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| Names of
children under 18 that intend to register a
sled:____________________________________________ |
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| Membership (includes
$5.00 NYSSA membership) |
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$25.00 |
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$________ |
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| Members
receive 2 club stickers |
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| Additional Stickers |
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____ @ $3.00 each = |
$________ |
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| Tax
deductable donation to the Northern Warren Trailblazers (501C-3) |
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$________ |
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OR |
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| Warren
County Association of Snowmobile Clubs membership $100 |
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$________ |
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includes a membership to each of the four clubs in warren county.) |
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| (Northern
Warren, South Warren, Thurman & Hague) |
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Total Amount enclosed: |
$________ |
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| Please
check this box if you are a member of another club from which you |
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already received a voucher or do not need a voucher |
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| By
signing below I am agreeing to adhere to the rules and regulations of NY
State Snowmobile Law, The Northern Warren |
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| Trailblazers
Snowmobile Club Inc, its insurance carriers, landowners and leaseholders. It
is agreed that the head of household |
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signing this agreement representing his/her entire family. |
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| Signature
___________________________________________ |
Date: __________________ |
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