HARDY COUNTRY SNOWMOBILE CLUB

NHSA CLUB #407

MEMBERSHIP APPLICATION                       JULY 01, 2007 TO JUNE 30, 2008

 (If you belong to another snowmobile club please enter your NHSA #)

MAILING INFORMATION:

NAME:_________________________________________________________  DATE:______________

ADDRESS:______________________________________________________ NHSA  #_____________

CITY/TOWN:______________________ STATE:_____________________  ZIP CODE:__________

HOME TELEPHONE NUMBER:(_________)_________________________

EMAIL ADDRESS :_______________________________________________

** NEWSLETTER WILL BE SENT THROUGH EMAIL IF AN ADDRESS IS PROVIDED.

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LOCAL INFORMATION:

ADDRESS:____________________________________________________________________________

 

SINGLE MEMBERSHIP     (age 18 or older)                                 $20.00               $_______________

(includes membership to New Hampshire Snowmobile Association)

FAMILY MEMBERSHIP  (2 adults and children under 18)        $25.00               $_______________

(includes membership to New Hampshire Snowmobile Association)

     PLEASE LIST FAMILY MEMBERS____________________

     ____________________________________________________

     ____________________________________________________

OVER 65 MEMBERSHIP   (SEE REQUIREMENTS)                    $10.00            $______________

  (includes membership to New Hampshire Snowmobile Association)            

  Applicant must be a minimum of 65 years of age. Must have been a member of the

   Hardy Country Snowmobile Club for FIVE (5) consecutive years.

DONATIONS:              GENERAL CLUB                                                                $_______________

    GROOMING                                                                        $_______________

                                        GROOMER                                                                          $_______________

                                        EASTER SEALS                                                                  $_______________

                                                                                                 TOTAL PAID              $_______________

 

APPLICANTS SIGNATURE:_______________________________________________________________