North Country ATV Club
Membership Form


Date:______________    New Member  ___     Renewal ___

Name____________________________________________________


Address___________________________________________________

Town _________________________State ________Zip____________

Telephone_________________________________________________

E-Mail ________________________

*If yes on family personalized include second name to be printed on card.

Single Membership         $15                Personalized Single        $16

Family Membership        $20                Personalized Family       $2
       No. in Family _____                      *Second Name _____________________

Trail Maintenance/Club Donation        ______________

Platinum Sponsor    ($500 & Over)     ______________   Platinum & Gold Sponsor let us know what
Gold Sponsor         ($250 & Over)      ______________   information you want on our web Ad.
Silver Sponsor        ($100 & Over)      ______________   Name to be published in our Newletters

                Total Amount Enclosed:  $______________
 
 Please mail to:
North Country ATV Club
PO Box 161
North Stratford, NH 03590