MEMBERSHIP FORM

Topsham Trailriders ATV/Snowmobile Club

PO Box 421
Topsham ME 04086

Membership Type:

Applicant Information
Name:
Date of Birth:	Phone:
Current Address:
City:	State:	Zip Code:
Email Address:
Emergency Contact
Name of the relative not residing with you:
Address:		Phone:
City:	State:	Zip Code:
Spouse Information if Joint Membership
Name:
Date of Birth:	Anniversary:
ATV Maine Accidental Death Insurance
This is the free accidental death and dismemberment insurance provided to A.T.V. Maine members. The new benefit will be $2500 for the member and family listed on the membership list with A.T.V. Maine. If you have any questions about this benefit or additional insurance, please call Shane Knowles at 207-318-9572 or spknowles@ailife.com.
Primary Member Beneficiary	Name:	DOB/
Spouses Beneficiary	Name:	DOB/
Children’s Beneficiary	Name:	DOB/
Children if membership privileges desired (must be 17 years old or younger)
Name:		DOB/
Name:		DOB/
Name:		DOB/
Name:		DOB/
Affiliate Membership
DO YOU BELONG TO ANOTHER CLUB? Yes IF SO, WHICH CLUB(S)
Disclaimer
I understand that by signing this form, my membership can be terminated at any time if the club or its officers have reason to believe that I or a member of my family operates an ATV irresponsibly so it endangers the landowner/club relationship or causes harm to individuals or property or commits any act that reflects negatively on the integrity of the organization. My membership fee is non-refundable and it is intended to be used to support the club as a whole. If my check is returned due to insufficient funds, my membership will not be valid until the membership fee and any charges are paid. I also agree to hold harmless the Topsham Trailriders ATV Club from all liabilities resulting from my involvement with the club.

MEMBERSHIP FORM

Topsham Trailriders ATV/Snowmobile Club

Applicant Information

Emergency Contact

Spouse Information if Joint Membership

ATV Maine Accidental Death Insurance

Children if membership privileges desired (must be 17 years old or younger)

Affiliate Membership

Disclaimer