Goodwill
Riders Snowmobile Club
YOU ARE INVITED TO JOIN OUR SNOWMOBILE CLUB
-
-
- FROM:
RANDY MACDONALD, MEMBERSHIP CHAIRPERSON
- GOODWILL RIDERS SNOWMOBILE CLUB, HAMPDEN, ME.
- YOU ARE INVITED
TO JOIN THE GOODWILL RIDERS SNOWMOBILE CLUB
- 844 WESTERN
AVENUE - HAMPDEN, MAINE
-
- IF
YOU HAVE AN INTEREST IN SNOWMOBILING, CROSS COUNTRY SKIING OR WOULD LIKE TO BECOME
A MEMBER AND SUPPORT OUR CLUB, PLEASE COMPLETE THE APPLICATION ON THE BOTTOM OF
THIS NOTICE. MAKE A CHECK PAYABLE TO GOODWILL RIDERS SNOWMOBILE CLUB AND
MAIL IT TO:
-
RANDY MACDONALD, 6 STETSON DRIVE, HAMPDEN, MAINE 04444
-
- MEMBERSHIP
FEES ARE AS FOLLOWS:
- $20.00
FAMILY, INCLUDES $2000.00 LIFE INSURANCE FOR HEAD OF HOUSEHOLD.
- $2.00 FOR
LIFE INSURANCE ON SPOUSE AND EACH ADDITIONAL FAMILY MEMBER UNDER 19
(OPTIONAL)
- IF
YOU HAVE ANY QUESTIONS, PLEASE CALL ME AT 862-5556. IF I AM AWAY,
- PLEASE
LEAVE A MESSAGE
AND I WILL RETURN YOUR CALL.
- NAME:
______________________________________________________
- MAILING ADDRESS: _____________________________________________
- CITY/TOWN:
_________________________________ STATE: ______________
- ZIP:
____________ TEL: __________________ DATE OF BIRTH: ______________
- BENEFICIARY
FOR MSA INSURANCE: _____________________________
- TOTAL
NUMBER OF FAMILY MEMBERS INCLUDING YOURSELF, SPOUSE
AND
- CHILDREN
UNDER 19 YEARS OF AGE ____________
-
- ADDITIONAL
INSURANCE COVERAGE OF IMMEDIATE FAMILY ONLY $2.00 PER DEPENDENT.
-
- DEPENDENTS
NAME: _____________________
DEPENDENTS NAME: _____________________
-
DATE
OF BIRTH: _____________________
DATE OF BIRTH: _____________________
-
RELATIONSHIP:
_____________________
RELATIONSHIP:
_____________________
-
BENEFICIARY:
_____________________
BENEFICIARY:
_____________________
- Western Avenue ·
Hampden, Maine 04444
- www.oocities.org/goodwillriders