Genesee
Sno-Packers Snowmobile Club Inc.
www.geneseesnopackers.com
Membership Application for
2011 – 2012 year
Mail to: PO Box 62 Oakfield, NY 14125
Type of Membership: NSSSA ID Number ____________(# on Membership Card)
[ ] Single (one
person) $30.00 Have
you already paid NYSSA Dues this season via another club? ____________
[ ] Family membership
$30.00
If
so, deduct $5 and enter name of club__________________________________
[ ] NYSSA
Trail Defender membership additional $20
. Total amount enclosed _____ _____ ____ _____
[ ] Donation
to the NYSSA Pac additional amount
**Make sure NAME and ADDRESS match your snowmobile registration!
First Name: ________________________________
Last Name: ________________________________
Spouse: ___________________________________
Home Phone: _______________________________
Address 1: _________________________________
Cell Phone: _________________________________
Address 2: _________________________________
If cell phone, Can we text you with updates? Yes of No
Town/City: _________________________________
Zip: _________________________________
County: ___________________________________
Email: ________________________________________________
{DMV Voucher, NYSSA Newsletter and other information can be emailed}
Check Events to work:
___ Chicken Barbeque,
___ Special Needs/Challenger Event, ___ Pancake Breakfast, ___ Trail Work
Number of snowmobiles being registered: _______
Number of household under age of 18: ____ Office Only
Voucher Number: _____
Paid by Check #: _____
or Cash FOR TOTAL: _____
Liability Disclaimer: I will
be responsible for myself and any passengers and assume all risks and
liabilities in the event of an accident, fire, and theft to myself, my
equipment or vehicle. I will not
hold the Genesee Sno-Packers Inc. or landowners responsible in event of
injury or damage. I will follow and
obey all New York State laws involving snowmobiles. I have read the NYS General Obligation
law 9-103 and understand that snowmobiling is a dangerous activity, which
can result in injury or death. Trail conditions vary
constantly because of weather changes and snowmobile use. I also understand that ice, variations
in terrain, moguls, rocks, forest growth, debris and other obstacles and
hazards, including other snowmobiler's, exist throughout the area. I will not make a claim against Genesee
Sno-Packers Inc., landowners, officers or members. I submit this application and promise to
comply with all current and future rules and regulations of the Genesee
Sno-Packers Inc. Snowmobile Club. [ ]
Twenty five cents of your $5 NYSSA dues will be used for the NYS
Snowmobile PAC (Political Action Committee) who is our voice in
Albany. If you do not wish to
contribute to the NYS Snowmobile PAC, please check this box. Please note, your NYSSA dues remain
$5.00. Members
must be 18 years of age or older to sign disclaimer. Signature: _________________________________ This is not the voucher form
required by the DMV 