2008 MEMBERSHIP APPLICATION

KNOWLES CORNER ATV CLUB, INC.
PO Box 244
Oakfield, ME. USA  04763

NAME ___________________________________  BIRTHDATE  ________
MAILING ADDRESS  ___________________________________________
CITY / STATE / ZIP  ____________________________________________
PHONE   (        ) _______________  E-MAIL ________________________
_________  $25.00 PRIMARY MEMBERSHIP (INCLUDES
SPOUSE + CHILDREN UNDER 18)
_________  $20.00  ASSOCIATE FAMILY MEMBERSHIP
NAME OF SPOUSE  _____________________________________________
NAME OF CHILDREN  _____________________ BIRTHDATE  _______
NAME OF CHILDREN  _____________________ BIRTHDATE  _______
___________  $20.00 PRIMARY SINGLE MEMBERSHIP
_________ $15.00 ASSOCIATE SINGLE MEMBERSHIP
Before joining as an associate member, a current year primary
membership with another ATV Maine affiliated club is required.
Membership is due in May of each year
NEW  _________  RENEWAL  __________
CHECK#  __________  CASH ___________  DATE PAID  ____________
Seasonal dues include $2000 Accidental Life & Dismemberment Insurance
BENEFICARY  ____________________  RELATIONSHIP  ____________________
PRIMARY CLUB  _________________  ASSOCIATE CLUB  __________________
Make checks payable to KC ATV Club, Inc.
PLEASE INDICATE BELOW ANY AREAS THAT YOU
WOULD BE WILLING TO GIVE A HELPING HAND WITH:
Trail Work ________________
Landowner Relations  ___
Signing Trails ____________
Fundraising ______________
Soliciting Food ___________
Social Functions _________
Help where Needed  _____

I understand that by signing this form, my membership can be discontinued at any time if the club or its officers have reason that I or a member of my family operates an ATV irresponsibly so that it endangers the landowner/club relationship or if it is believed that the operator could cause harm to another individual. My membership fee is non-refundable and it is to be used to support the club as a whole. I also agree to hold harmless the KC-ATV Club from all liabilities resulting from my involvement with the club.
APPLICANT'S SIGNATURE _________________________________________