MEMBERSHIP APPLICATION FORM 2007-2008

        Paul Bunyan Snowmobile Club Member  (standard membership)    

        Associate Member – Current member of_________________________ Snowmobile Club 

        Business Member

Name:

Address:

City, State, Zip:

Telephone:

E-mail Address:

Date of Birth:

I would like to help with __ activities, __ trails, __ landowner relations,            

__ club rides, __ fundraising, __ just support the club as a member

Beneficiary for Insurance:

Total # of Family Members:

 You may purchase additional insurance for $2 per dependent, which is a spouse or a dependent child under 19 years of age.  Please list additional dependent  below (add $2 for each additional dependent):

Name:

Date of Birth:

Relationship to Member:

Beneficiary:

 Membership is $24.00 per family membership ($40business; $12 associate) with $2 for each additional dependent insurance you request. 

Signature: _____________________________________________   Date: __________

Checks should be made payable and mailed to:

Paul Bunyan Snowmobile Club, PO Box 2144, Bangor, ME  04402-2144