Southern Adirondack Snowmobile Club, Inc.

PO Box 142, Mayfield, New York 12117

2008-2009 Snowmobile Season Application

Voucher ID#

Please Print Clearly and Mark All Applicable Boxes!

Name:

Spouse's Name:

If you have any children under the age of 18 that will be registering a snowmobile in

their own name please list them below (Children over 18 must join as a separate

member if they wish to register their snowmobile in their own name).

Mailing Address:

If the address you have your snowmobile(s) registered to is different than the

address listed above please give us that address below:

Phone Number:

Email Address:

Type of Membership:

Single ($25)

Family ($30)

Advertising ($30)

Would you like to donate to the Groomer Fund?

Yes

If so, how much will you be donating

Would you or any member of your family like to participate in work parties

or help out at club events?

Yes

If so, please give us any special contact information we could have and let

us know what you would be interested in helping out with.

$5.00 of every membership goes to the NYSSA for your dues. If you belong

to another snowmobile club and have already paid your NYSSA dues

through them please deduct $5.00 from your SASC membership payment

and check the box to the right.

Twenty-five cents of your NYSSA dues will be used for the NYS Snowmobile PAC

(Political Action Committee) who is your voice in Albany. If you do not wish to

contribute to the the NYS Snowmobile PAC, please check the box below. Please note,

your NYSSA dues will still be $5.00 if you choose not to contribute.