MEMBERSHIP / RENEWAL APPLICATION
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MEMBERSHIP / RENEWAL APPLICATION 12 month membership in Quad Cities ATV Club (Annual renewal); Quad Cities ATV newsletter (one issue per year); Membership to ATVAM, the All-Terrain Vehicle Association of Minnesota; Subscription to Minnesota Off-Road Magazine (six issues per year). Quad Cities ATV Club • P.O. Box 83 • Virginia, MN 55792 • quadcitiesatv.com • [email protected] Annual Membership Fees: Current ATVAM Member through another ATV Club Individual ................................................... $25.00 Individual ................................................... $5.00 Family ......................................................... $30.00 Family .......................................................$10.00 Business: Business.................................................. $30.00 Silver ..............................................$100.00 Current ATVAM Member ID ______________________ Gold.................................................$150.00 I would like to donate Platinum ....................................... $200.00 an additional $_________________________________ Contact Information: Name(s) __________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Children with ATV Safety Certificates _________________________________________________________________________________________________________________________________________________________ Children you wish to become ATV Certified __________________________________________________________________________________________________________________________________________ Address: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________ City: ______________________________________________________________________________________________________State: _________________________________________________Zip: __________________________________________________________ Phone (home): ____________________________________________________________________________(cell): _____________________________________________________________________________________________________________________ Email: (please write neatly) _________________________________________________________________________________________________________________________________________________________________________________ Signature: _____________________________________________________________________________________________________ Date: ___________/__________/________________ Check Payable to Quad Cities ATV Club Check #: _______________________________________________________________________________________________________________ For more information contact one of our club officers: Dave Dincau • 218-780-4522 • [email protected] Ryan Horan • 218-290-3315 • [email protected] • Al Larsen • 218-780-5543 • [email protected] Jon Ahola • 218-248-0925 • [email protected] • Lisa Suihkonen • 218-290-3700 • [email protected] Dan Lauritsen • 218-780-1732 • [email protected] • Cindy Lauritsen • 218-744-1528 • [email protected] Shannon Bergman • 218-966-9838 • [email protected] • Jeff Leese • 218-750-7652 • jeffl@wafishermn.com John Vukmanich • 218-410-3308 • [email protected] • Ed Cvek • 218-780-0084 • [email protected]
Transcript of MEMBERSHIP / RENEWAL APPLICATION
MEMBERSHIP / RENEWAL APPLICATION12 month membership in Quad Cities ATV Club (Annual renewal);
Quad Cities ATV newsletter (one issue per year);Membership to ATVAM, the All-Terrain Vehicle Association of Minnesota;
Subscription to Minnesota Off -Road Magazine (six issues per year).
Quad Cities ATV Club • P.O. Box 83 • Virginia, MN 55792 • quadcitiesatv.com • [email protected]
Annual Membership Fees: Current ATVAM Member through another ATV ClubIndividual ...................................................$25.00 Individual ...................................................$5.00 Family .........................................................$30.00 Family .......................................................$10.00Business: Business .................................................. $30.00 Silver ..............................................$100.00 Current ATVAM Member ID ______________________ Gold .................................................$150.00 I would like to donate Platinum ....................................... $200.00 an additional $_________________________________
Contact Information:Name(s) __________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Children with ATV Safety Certifi cates _________________________________________________________________________________________________________________________________________________________ Children you wish to become ATV Certifi ed __________________________________________________________________________________________________________________________________________ Address: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________ City: ______________________________________________________________________________________________________State: _________________________________________________Zip: __________________________________________________________ Phone (home): ____________________________________________________________________________ (cell): _____________________________________________________________________________________________________________________ Email: (please write neatly) _________________________________________________________________________________________________________________________________________________________________________________ Signature: _____________________________________________________________________________________________________ Date: ___________/__________/________________
Check Payable to Quad Cities ATV Club Check #: _______________________________________________________________________________________________________________
For more information contact one of our club offi cers: Dave Dincau • 218-780-4522 • [email protected] Horan • 218-290-3315 • [email protected] • Al Larsen • 218-780-5543 • [email protected] Ahola • 218-248-0925 • [email protected] • Lisa Suihkonen • 218-290-3700 • [email protected]
Dan Lauritsen • 218-780-1732 • [email protected] • Cindy Lauritsen • 218-744-1528 • [email protected] Bergman • 218-966-9838 • [email protected] • Jeff Leese • 218-750-7652 • jeffl @wafi shermn.com
John Vukmanich • 218-410-3308 • [email protected] • Ed Cvek • 218-780-0084 • [email protected]
