Northern Lights ATV Club Membership Application
(This is a yearly application fee)

( ) New                        ( ) Renewal

Name: __________________________________________________
            (first)                                                 (last)

Address: _{____________________________________________________
                (street)
                ________________________________________
                 (city)                                                                    (state)                    (zip)}

_{Phone: (___)-__________(___)-_____________(___)-________________
                    (home)                                                    (work)                                                           (cell)
                        - Please include area codes}

_{Email Address: ________________________________________________}

_{Volunteer: ( )yes   ( )Trails  ( )Club Administration  ( )Other, Specify:________}

_{Type Of Membership:    ( ) Individual - $25.00
                                     ( ) Family - $35.00
                                     ( ) Business - $100.00
Date: __________    Paid: ________    ( )Cash    ( )Check, Check Number:____}

_{Are you a member of another ATV Club that is affiliated with ATV Maine? ( )Yes  ( )No}

_{If YES, Name of Club: _____________________________________
Are you a member of ATV Maine? ( )Yes  ( )No}

_{Please make check payable to Northern Lights ATV Club. If mailing please send to:
Northern Lights ATV Club
P.O. Box 336
Greenville, ME. 04441
---------------------------------------------------------------------------------------------------------------------
NLATV Membership 2005-2006 Receipt
Rec'd Of: ____________________________________________________
Date: _________ Paid: _________ ( )Cash    ( )Check, Check Number:______}