Triad trailblazers

Membership Application

Contact Information:

Name:		DOB:
Address:

City:

State:

Zip:

Phone:	Home:
	Work:
	Cell:
	Other:

E-mail Address:
Internet Screen name:

In Case of Emergency Contact:

Name:

Phone:	Home:
	Work:

Annual Membership Dues

Membership (includes family members) $20.00

I have read and agree to abide by the rules and bylaws as set forth by the club at all times.

I understand that the Triad TrailBlazers ATV/UTV Club will not be held responsible for any accidents that may occur. When riding, I ride at my own risk. The landowner nor the club is responsible for any accidents.

Signature _________________________________________Date________________
Please print, and bring copies with you to the next club meeting.