CLUB APPLICATION
____YES! I am interested in joining the Bridgton Easy
Riders Snowmobile Club. My check for the membership
is attached. I will receive the following benefits:
Membership in the Bridgton Easy Riders; membership
in the Maine Snowmobile Association (MSA); $2,000
Accidental Death or Dismemberment Insurance for
applicant. An eligible dependent is a member's spouse
or a member's unmarried child but less than 19 years old.
Name __________________________________________
Date of Birth _____________
Address ___________________________________
Phone __________________
Town_________________________________
State_____ Zip ____________
Number of Family Members ________________
List Each Dependent (wife and/or children under 19
Name and Birth date for MSA Dependent insurance:
Name ________________________
Date of Birth ____________
Name ________________________
Date of Birth ____________
Name ________________________
Date of Birth ____________
Membership $30.00
Please mail this form & your check to:
Bridgton Easy Riders Snowmobile Club
PO Box 564
Bridgton, ME 04009