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Triad TrailBlazers ATV Club
Membership Application

NAME:________________________________________ Address:_____________________________________ City: ___________________ State __________Zip______ Phone (home)________________ (Work)________________ (Cell)________________ Email Address____________________ Screen name________________ Date of Birth___________________
In Case of Emergency Contact: Name ______________________ Phone # work_______________ Phone # home_______________ Phone # other _____________
Type of Membership ( ) Single Membership $15.00 ( ) Family Membership $20.00 ( ) Business Sponsor $60.00 (Includes an Ad on Club Web site)
I understand that the Triad Trail Blazers ATV Club is not and will not be responsible for any accidents that may occur. When riding, regardless of who the landowner is, I ride at my own risk. The landowner nor the club is responsible for any accidents. Also, I am solely responsible for any and all damages to property that are a result of my actions as an ATV rider.

I agree to abide by the rules set forth by the club at all times.

Signature _____________________Date________________