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| Brettuns Wheelers Membership Application |
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Brettuns Wheelers ATV Club
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| ____$20.00 Single Membership |
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| ____$25.00 Family Membership |
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| ____$35.00 Supporting Business Membership |
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| All membership fees include ATV Maine Membership ( if already a member subtract $5 ) |
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| 2006 - Club Membership Application |
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| Club Membership Year: 06/01/06 to 06/01/07 |
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| Name_______________________________________________________________________ |
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| Address_____________________________________________________________________ |
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| Town, State, Zip,_______________________________________________________________ |
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| Phone Number______________________________e-mail______________________________ |
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| Do you belong to another club ATV or Snowmobile?____________________________________ |
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| List all family members under membership |
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| Spouse______________________________________________________________________ |
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| Child1_______________________________________________________________________ |
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| Child 2_______________________________________________________________________ |
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| Child 3_______________________________________________________________________ |
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| ATV/Year/Make_______________________________________________________________ |
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| __Trail work + any equipment __Landowner relations __Safety training __Search+Rescue __Boards/Committees __Fundraising __Activities/Events __Help where needed |
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| How / where did you hear about the ATV Club? |
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| _______________________________________________________________________________ |
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| I understand that by signing this form, my membership can be discontinued at any time if the club or its officers have any reason to believe that I or any of my family operates an ATV irresponsibly so that it endangers the landowner/club relationship or |
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| f it is believed that the operator could cause harm to another individual. My membership fee is non-refundable and is intended to be used to support the club as a whole. I also agree to hold harmless the ATV Club from all liabilities resulting from my |
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| nvolvement with the club. |
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| Signature:____________________________________________Date:___/___/___ |
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| Meetings are held at 971 River Rd, Livermore |
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| 2nd and 4th Tuesday of every month |
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| Please come to our next meeting or mail this form to: |
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Please make checks payable to Brettuns Wheelers ATV Club
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