Deerfield Snow Trails Inc.

P.O. Box J

Marcy, NY 13404

315-7330082 (application issues)

Membership Application

(Renewals: only need to record changes)

(Please Print)

Name :___________________________   Spouse / Children's Names (optional)        ___________________________

Physical Address :________________________________________________       ___________________________

P.O. Box : _______________________________________________________       ___________________________

City : ______________________State : ______________  Zip : ____________       ___________________________

County :________________________________________________                         ___________________________

Number of Sleds Registering from this residence : ______________                                                                                                

E-Mail Address : __________________________(needed to receive Club News Letter, DMV Voucher, & NYSSA News)

Phone Number : __________________                                                                                                                                                  

Membership Dues : $25.00 (includes $ 5.00 NYSSA dues)                                                                                                                   

           $ 20.00 (if you paid NYSSA dues thru another club. You will not receive a voucher)          

           Name of club you paid NYSSA dues to :_________________________________         

______  Check Here if you wish 25¢ of your $ 5.00 NYSSA dues to go to its political action committee                   

______  Check Here if you included an additional $ 20.00 to support the "trail defender" fund.                               

______ Check Here if you wish to received 3rd party ads through NYSSA                                                                    

Applicant Signature : _____________________________________    Date : __________________