High Mountain ATV, Inc.
2011 Membership Form
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..... New ( ) or Renewal ( )
>
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:
________________________________________________________________________
If Business Membership, please
enclose your business card. Thank you.
Funds Attached:
$__________________
NOTE: Dues are on an annual basis
with a due date of January 31st.
Dues for new members that are
posted after October 1st include the following year.
Your Signature:
___________________________________ Date: _______________
If new member is under the age of 18, a parent or guardian must also sign below.
Parent/Guardian:
____________________________________ Date: _______________
If your membership is the result
of efforts by a current member,
please let us know who we should give
credit to:_________________________________________
High Mountain ATV Association,
Inc.
P.O. Box 805
Wallace, ID 83873
Phone: 208.512.2269
Email: hmatva@cebridge.net