Van Buren ATV Club

P. O. Box 473

Van Buren, ME  04785

www.vbpinerunners.com

                      Date: ___________________ Renew Membership: _____ New Member: ______

Name: ________________________________________________ Age: _____

Spouse: _______________________________________________ Age: _____

Address: ________________________ City: _____________ State: _________

Zip Code/ Postal Code: _________________ Phone No: __________________

 _

E-Mail Address: __________________________________________________

or

Associate Membership:                                                           $15.00  ________                               

( Only if you paid ATV Maine Dues of  $10.00 to another club )                           

What is that Primary Club’s Name: _____________________________________________ 

ATV Maine Sticker - Please add $1.00 extra each.                   $1.00 ea.    ________    Needed on Irving Lands        

or

Extra Club Stickers: _____   ATV Maine Stickers: _____    $1.00 Each:  ________

                                                                                                                  Total: ________

Please Make Check Payable To: VAN BUREN ATV CLUB

Would You Be Interested In Helping Out With:

Hosting Hot Dog Roast: ___ Search & Rescue: ___ Club Rides: ___

Cutting Grass At Picnic Site: ___ At Garage: ___ At Parking Area: ___

Working in Trails: ___ Trail Signs: ___  Other: ___________________

Family Members Under 18:

Name: ____________________________________________ Age: _____

Name: ____________________________________________ Age: _____

Name: ____________________________________________ Age: _____

I understand that by signing this form, my membership can be discontinued at anytime if the club or its officers have reason to believe that I or a member of my family operates an ATV irresponsibly so that it endangers the landowner / club relationship or if it is believe that the operator could cause harm to another individual.  My membership fee is non-refundable and it is intended to be used to support the club as a whole.  I also agree to hold harmless the Van Buren ATV Club from any liabilities resulting from my involvement with the Club.

Signature: _____________________________________