Snow
Pioneers 1582 210th
Street, Manchester, IA 52057
Membership
Application
October 1, 2007 to
September 30, 2008
In
consideration of your accepting this application, I hereby for myself, my
heirs, executor, and administration, and/or the minors for whom I am
signing, release and forever discharge the sponsor, co-sponsors and agents,
servants, other club members, land owners or managers of land I may be using
or owners of any equipment I may use of and from any and all loss, damage or
injury by me or my equipment.
I
agree to abide by the By-laws of this club. I understand that state law
requires that I carry liability insurance for any and all snowmobiles
operated by myself and/or the minors for whom I am signing, on any and all
public or private trials.
The
Snow Pioneers club membership fee includes membership in the Iowa State
Snowmobile Association (I.S.S.A.). The membership year to I.S.S.A. runs
from January 1st to December 31st each year.
Membership dues to I.S.S.A. are $15.00 for January 1, 2008 to December 31,
2008. This is the only organization that represents all snowmobilers in
Iowa. Their accomplishments in the past are considerable and the future of
the sport of snowmobiling in Iowa, if it’s to continue to advance, will need
the support of all snowmobilers.
PLEASE PRINT – FILL IN COMPLETELY
| Name of Applicant: |
DOB: |
| Spouse: |
DOB: |
Name of Children:
(include Date of Birth for accidental death insurance coverage) |
DOB: |
| Address: |
|
| City, State, Zip: |
|
| Home Phone: |
|
| Cell Phone: |
|
| E-mail Address:
|
|
Would you like to
receive Newsletter & other updates by email?
Yes___ No___ |
|
Membership (*includes $15.00 to
I.S.S.A.)
* If you are a member of ISSA
through another club, you do not need to join again |
$25.00_____________ |
| Donation: |
_____________
|
| Sponsorship: |
$50.00_____________ |
| Other: |
_____________ |
|
Total Amount : |
$_____________
Due10/01/2007 |
| Please make checks payable
to: SNOW PIONEERS
|
|
Mail application
to: Steve Vorwald
1582 210th Street
Manchester, IA 52057 |
I have read and understand
the above and I hereby affirm that these statements are true.
Date:__________________
____________________________________________