MEMBERSHIP APPLICATION

SMOKI HAULERS SNOWMOBILE CLUB
PO Box 331
Oakfield, ME  04763
Tel. (207) 757-7428

Membership dues include $2,000 insurance for head of household

NAME ____________________________________________________________________
-
MAILING ADDRESS __________________________________________________________
-
CITY, STATE, ZIP ___________________________________________________________
-
TELEPHONE (         ) ____________________ DATE OF BIRTH _______________________
-
E-MAIL ADDRESS ____________________________________________________________
-
BENEFICIARY _______________________________________________________________
(you must name a beneficiary for the insurance)
-
COMPLETE THE FOLLOWING FOR EACH DEPENDENT YOU WISH TO INSURE:

       NAME              RELATIONSHIP             DATE OF BIRTH              BENEFICIARY

1 _________________________________________________________________________

2 _________________________________________________________________________

3 _________________________________________________________________________

4 _________________________________________________________________________

5 _________________________________________________________________________

 

What activities would you be interested in?
______ 1. Bridge Upkeep
______ 2. Annual chicken BBQ
______ 3. Poker Runs
______ 4. Kids Day
______ 5. Winter grooming (learn Bombi)
______ 6. Writing an article for the newsletter
______ 7. Landowners appreciation supper
______ 8. Building & grounds upkeep
______ 9. V.K. Drag
_____ 10. Fundraisers
_____ 11. Spaulding Lake Cookout
_____ 12. Public Supper
_____ 13. Hunters Breakfast
_____ 14. Pine tree rep.
_____ 15. Christmas Party
_____ 16. Organizing trail rides
_____ 17. Trail work
_____ 18. Brushing
_____ 19. Signage
_____ 20. Secure use permits

Primary Membership
(including insurance coverage) = $25.00

Dependent insurance
Number of dependents ____ x $2.00 = $_______

TOTAL ENCLOSED = $_______

Thank you!