2003 - 2004

HORSEHEADS SNOWMOBILE CLUB

MEMBERSHIP APPLICATION

NEW RENEWAL (CIRCLE ONE)

NAME ______________________________ SPOUSE'S NAME ___________________________

ADDRESS _______________________ CITY ______________ STATE _______ ZIP __________

TEL # __________________ DOB: ________________ OCCUPATION _____________________

# SLEDS OWNED ________ DATE _____________ E-MAIL** ____________________________

**If you are willing to accept the monthly newsletter via e-mail, please check here: _______________

FAMILY & SINGLE MEMBERSHIP (Family includes children 18 yrs. and younger)

____ $45.00 NEW (Includes NYSSA Membership ____$40.00 RENEWAL (Includes NYSSA Membership)

MEMBERSHIP COMMITTEE CHOICES: (CIRCLE ONE or MORE)

1. BUILDING MAINTENANCE 2. TRAIL MAINTENANCE 3. SOCIAL EVENTS
4. FUND RAISING 5. TELEPHONE TREE 6. LAWN CARE
7. POKER RUNS 8. WOOD CUTTING  
9. GROOMING 10. HOUSECLEANING  

PLEASE SEND APPLICATION AND REMITTANCE TO:

HORSEHEADS SNOWMOBILE CLUB

PO BOX 385

ODESSA, NY 14869

BY ACCEPTANCE OF THIS APPLICATION – I WILL ABIDE BY THE BYLAWS OF THE HORSEHEADS SNOWMOBILE CLUB, INC.

Signature of Applicant: _________________________________________________________