SSTB ONLINE MEMBERSHIP

SINGLE-$25
FAMILY-$40 PER FAMILY OF 2

Please provide the following contact information * REQUIRED FIELDS:

PLEASE USE FULL REGISTRATION NAME ON FORM (NO NICKNAME)

MAKE SURE YOU HAVE YOUR REGISTRATION NUMBER FROM THE SIDE OF THE SLED

YOU MUST ANSWER THE THREE (3) QUESTIONS AT THE BOTTOM

**PLease allow 2 or 3 days for processing. if you need a voucher TODAY than go to **nyssa**

Please provide the following contact information:

First Name *

Last Name *

Street Address *

Address (cont.)

City *

State/Province *

Zip/Postal Code *

County *

Home Phone *

Name On Credit Card or Check
DO NOT PUT CREDIT CARD NUMBER *

Amount You Are Paying *($25.00 or $40.00)

E-mail

Second Family Member Name Needed For Family Membership ONLY! MUST Live At The Same Address

Number of Snowmobiles

*

Sled 1 YEAR and MAKE (example 2002 Skidoo)

*

Sled 1 Registration Number From Side of Sled (This is needed to complete your membership)

*

Sled 2 YEAR and MAKE

Sled 2 Registration Number

Sled 3 YEAR and MAKE

Sled 3 Registration Number

Sled 4 YEAR and MAKE

Sled 4 Registration Number

Sled 5 YEAR and MAKE

Sled 5 Registration Number

1. Have you already paid NYSSA Dues this season via another club? *

If YES, which Club

2. *Twenty five cents of your $5 NYSSA dues will be used for the NYS Snowmobile PAC (Political Action Committee) who is our voice in Albany. If you do not wish to contribute to the NYS Snowmobile PAC, please check this box. Please note, your NYSSA dues remain $5.00.

3. Landowner on our trail? *

Copyright © 2006 South Shore Trailblazers. All rights reserved.
Revised: 11/15/08

*First Name*	*
*Last Name*	*
*Street Address*	*
Address (cont.)
City	*
State/Province	*
Zip/Postal Code	*
County	*
Home Phone	*
Name On Credit Card or Check DO NOT PUT CREDIT CARD NUMBER	*
Amount You Are Paying	*($25.00 or $40.00)
E-mail

Copyright © 2006 South Shore Trailblazers. All rights reserved. Revised: 11/15/08

Copyright © 2006 South Shore Trailblazers. All rights reserved.
Revised: 11/15/08