Bridgton Easy Riders Snowmobile Club, P.O.Box 564, Bridgton, Maine 04009
E-MAIL - chapmanpug@yahoo.com WEB:
 
                                            CLUB APPLICATION

____ YES! I am interested in joining the Bridgton Easy Riders Snowmobile Club. My check for $25.00 membership fee 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
               (additional dependents $2.00 each)
        600 Mile Lakes Region Snowmobile Trail Map
        One year subscription to the Maine Snowmobile Publication
Name _____________________________Date of Birth __________________

Address ___________________________ Phone _____+ ________________

Town _____________________State __________ Zip Code ______________

Beneficiary ______________________ E-Mail: ______________________

Number of Family Members ________________________________________
List Each Dependent (wife and/or children under 18) Name and Birthdate for MSA Dependent insurance: _____________________________________________
Please mail with your check for the correct amount to: Bridgton Easy Rideers Snowmobile Club, PO Box 564, Bridgton, ME 04009