BUSINESS MEMBERSHIP
Please print this page and mail application to :
Crooked river Snowmobile, PO Box 42, S. Casco, ME 04077
FAMILY MEMBERSHIP
$25 /year. Entitles you to receive the MSA Magazine   “ The Maine         Snowmobiler” and MSA insurance.
$50 entitles business to an ad on the rear of club trail map , mention in each “Snowmobiler” magazine and the “The  Maine Snowmobiler” itself.
HOME PAGE
SUPPORTING BUSINESS MEMBERSHIP
Maine Snowmobile Association
Date:....................
Business Name:................................................................................
Mailing Address:...............................................................................
City/Town:...........................................................State:......................
Zip:...............................Tel:................................................................
Crooked River Snowmobile Club of Casco, Maine
Business Owners Name:.................................................................. Email ................................................................................
Additional Accidental Death and Dismemberment Coverage of Eligible Dependents is available for $2 per Dependent.
Dependents name:..................................................................................
Date of Birth:...........................Relationship:..........................................
Beneficiary:.............................................................................................
Dependents name:..................................................................................
Date of Birth:...........................Relationship:..........................................
Beneficiary:.............................................................................................
Dependents name:..................................................................................
Date of Birth:...........................Relationship:..........................................
Beneficiary:.............................................................................................
Eligible Dependents are the named member’s spouse and any unmarried dependent child who is at least 14 days, but less than 19 years of age and Not in active military service. Children include natural, step, faster or adopted children.
Name:..............................................................................................
MSA Family Membership
Date:.................
Mailing Address:.............................................................................
City/Town:..........................................................State:....................
Zip:...........................Tel:.................................Date of Birth:..........
E-Mail Address:..............................................................................
Beneficiary for MSA Insurance:.....................................................
Crooked River Snowmobile Club, Casco, ME
Total No. People in Family:.........