Northern Lights ATV Club Membership Application

(This is a yearly application fee)

( )New Member or ( ) Renewal

Name: _________________________________________________________

(first)                                                    (last)

Address: ________________________________________________________

(street or PO Box)

________________________________________________________

(city)                                                                   (state)                   (zip)

Phone: (___)-____________ (___)-_____________ (___)-________________

(home)                                            (work)                                        (cell)
- Please include area codes

Email Address: ________________________________________________

Volunteer: ( ) Yes, with:  ( ) Trails  ( ) Club Administration

( )Other, Specify:________

Type Of Membership:  ( ) Individual - $25.00
                                        ( ) Family - $35.00
                                        ( ) Business - $100.00

Date: __________  Amt Paid: ________ ( )Cash  ( )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

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NLATV Membership 2005-2006 Receipt

Rec'd Of: ____________________________________________________

Date: __________ Amt Paid: _________ ( )Cash  ( )Check (Number:_________)