CLUB APPLICATION

____ YES! I am interested in joining the Bridgton Easy Riders Snowmobile Club. My check for the membership 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 Code _______

Number of Family Members ________________________
List Each Dependent (wife and/or children under 19) Name and Birthdate for MSA Dependent insurance:

Name ___________________  Date of Birth __________               

Name ____________________Date of Birth __________               

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

                                                                    P O Box 564

                                                                    Bridgton, Maine 04009