Burnt Meadow Snowmobile Club Application for Membership
Annual Dues $22.00 Business membership $30.00
Name: ___________________________________________________________
Mailing Address: __________________________________________________
Town: __________________________ State: ____________ Zip: ___________
Telephone: _______________________________________________________
Email: ____________________________________________________________ Birth date: _________________ Age: _______ No. of Family Members: _______ Beneficiary for MSA Insurance: ________________________________________ Check One: New Member _____ Renewal: _____ New MSA Member: _________ Do you support other clubs: ______ Name: ______________________________ What do you Ride: ___________________________________________________ Please print out this application and mail to the club! Burnt Meadow Snowmobile Club P.O. Box 412 Brownfield ME 04010