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MOOSEHEAD RIDERS MEMBERSHIP APPLICATION

NAME ____________________________________________________ DATE__________

ADDRESS_____________________________________________________________

CITY/TOWN_____________________________________________ STATE_______ Zip______________

TEL______________________________ DATE OF BIRTH_________________ # IN FAMILY________

EMAIL ADDRESS_____________________________________________________________

BENEFICIARY FOR MSA INSURANCE_______________________________________________________

ADDITIONAL DEPENDENT INSURANCE (included) FOR:

NAME____________________________________________DATE OF BIRTH________________

MEMBER’S SPOUSE or CHILD(CIRCLE ONE)BENEFICIARY_________________________________

ADDITIONAL DEPENDENT INSURANCE FOR:

NAME____________________________________________DATE OF BIRTH________________

MEMBER’S SPOUSE OR CHILD(CIRCLE ONE)BENEFICIARY_________________________________

ENCLOSE MEMBERSHIP DUES PAYABLE TO MRSC AND RETURN TO:

MOOSEHEAD RIDERS SNOWMOBILE CLUB

P.O. BOX 1145

GREENVILLE, ME 04441

DUES SCHEDULE: FAMILY 33.00 BUSINESS $43.00 AFFILIATE 20.00

Name of Club Member sponsor (for new members only)

_______________________________________________
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	WELCOME MOOSEHEAD RIDERS SNOWMOBILE CLUB MEMBERSHIP PAGE OUR CLUB MEETINGS ARE HELD THE SECOND SATURDAY OF EACH MONTH (SEPT THRU APRIL) AND INCLUDES A POT LUCK SUPPER. THE CLUB ALSO SPONSERS MANY SOCIAL ACTIVITIES AND FUNCTIONS THROUGHOUT THE SEASON. YOUR SUPPORT HELPS THE CLUB PROVIDE OVER 100 MILES OF GROOMED TRAILS ALL WITH VOLUNTEER WORKERS. WE ALSO HAVE A WONDERFUL CLUBHOUSE FOR OUR FUNCTIONS AND WE ARE OPEN WITH VOLUNTEER HELP ON SATURDAY AND SUNDAYS FOR BREAKFAST AND LUNCHES. A SMALL SAMPLE OF CLUB FUNCTIONS: CHRISTMAS PARTY/YANKEE SWAP/POT LUCK SUPPER B-52 MEMORIAL RIDE AND LUNCH SNOFEST NEW THIS SEASON FULL MOON RIDES!! WEDNESDAY RIDES SATURDAY GROUP RIDES AND SUPPER ANNUAL BANQUET AND MUCH MUCH MORE! JOINING US IS EASY, JUST HIGHLIGHT THE APPLICATION COPY AND FILL IT OUT. YOU CAN MAIL IT ALONG WITH A CHECK PAYABLE TO MOOSEHEAD RIDERS OR YOU CAN BRING IT WITH YOU TO THE CLUBHOUSE ON THE WEEKENDS! WE CAN ALSO SEND YOU AN APPLICATION. EMAIL US OR CALL! SO WHAT ARE YOU WAITING FOR?

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