2010 Membership Form
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..... New ( ) or Renewal ( )

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Name: _________________________________________ Date : __________________

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Address: _______________________________________________________________

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City: ________________________State: ____________________ Zip: _____________

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Telephone: ( _____ )___________________ E-mail: ______________________________

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Type of Membership desired:

( )  Individual:       $15
( )  Family:            $20
( )  Business:        $35

If Family Membership, please list the members of your family who live in your household:

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________________________________________________________________________

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If Business Membership, please enclose your business card. Thank you.

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Funds Attached: $__________________

NOTE: Dues are on an annual basis with a due date of December 31st. 
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Dues for new members that are posted after October 1st include the following year.

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Your Signature: ___________________________________ Date: _______________

If new member is under the age of 18, a parent or guardian must also sign below.

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Parent/Guardian: ____________________________________ Date: _______________

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If your membership is the result of efforts by a current member, please let us know

 who we should  give credit to: ________________________________________

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High Mountain ATV Association, Inc.
P.O. Box 805
Wallace, ID 83873

Phone:  208.512.2269
Email:   hmatva@cebridge.net