The Wilderness Riders of Kenora
			514 6th Ave. S. Kenora, ON P9N 2C5
			www.oocities.org/wilderness_riders
			MEMBERSHIP APPLICATION
NAME:
ADDRESS:
PHONE:				FAX:
e-mail:
TYPE OF MEMBERSHIP:			FAMILY		SINGLE		ASSOCIATE
(circle correct one)
ADDITIONAL FAMILY MEMBERS NAMES:					PUT X IF OVER 12 YEARS OLD
DATE:				SIGNATURE:
In consideration of the acceptance to join, members, by the execution of this form expressly release
and discharge the organizers of any Wilderness Riders event, the Board of Directors and all others
involved in the Wilderness Riders, of any and all damages, injury, losses or claims from any member
to his/her person or property.
---------------------------------------------------------Office Use Only --------------------------------------------------------------
			The Wilderness Riders of Kenora
			514 6th Ave. S. Kenora, ON P9N 2C5
			RECEIPT
MEMBERSHIP FEE PAID:			FAMILY	$15.00	SINGLE	$10.00	ASSOCIATE	$5.00
(circle correct one)
DATE:				SIGNATURE: