Meeting Information

Contact the Club
Your Name:
Email:
Phone:
Subject:
Message:

Business Sponsors

Lake Region House of Pizza
224 Portland Road
Bridgton ME 04009
Phone:(207) 647-4611

Maine Jet Ski & ATV Rental Co.
342 Roosevelt Trail
Casco Me. 04015
Phone:(207) 655-3213

New England Boat and Recreation
255 Portland Road
Bridgton ME 04009
Phone:(207) 647-3030
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
Return to Home Page Wednesday, March 10, 2010
 

MEMBERSHIP FORM

Lakes Region ATV Club

PO Box 1718
Naples ME 04055

Applicant Information
Name:
Date of Birth: Phone:  
Current Address:
City: State: Zip Code:
Email Address:

Emergency Contact
Name of the relative not residing with you:
Address: Phone:
City: State: Zip Code:

Spouse Information if Joint Membership
Name:  
Date of Birth: Anniversary:  

ATV Maine Accidental Death Insurance
This is the free accidental death and dismemberment insurance provided to A.T.V. Maine members. The new benefit will be $2500 for the member and family listed on the membership list with A.T.V. Maine. If you have any questions about this benefit or additional insurance, please call Shane Knowles at 207-318-9572 or spknowles@ailife.com.
Primary Member Beneficiary Name: DOB/
Spouses Beneficiary Name: DOB/
Children’s Beneficiary Name: DOB/

Children if membership privileges desired (must be 17 years old or younger)
Name: DOB/
Name: DOB/
Name: DOB/
Name: DOB/

Affiliate Membership
DO YOU BELONG TO ANOTHER CLUB? Yes

IF SO, WHICH CLUB(S) 		 

Disclaimer
I understand that by signing this form, my membership can be terminated at any time if the club or its officers have reason to believe that I or a member of my family operates an ATV irresponsibly so it endangers the landowner/club relationship or causes harm to individuals or property or commits any act that reflects negatively on the integrity of the organization. My membership fee is non-refundable and it is intended to be used to support the club as a whole. If my check is returned due to insufficient funds, my membership will not be valid until the membership fee and any charges are paid. I also agree to hold harmless the Lakes Region ATV Club from all liabilities resulting from my involvement with the club.