Trailblazers Off Road Club
www.trailblazersoffroadclub.com
Name_______________________________________ Membership Application
Address_____________________________________ ____Sponsor $35.00
City_____________________ County_____________ ____Single $10.00
State______________________ Zip______________ ____ Family $15.00
Telephone_____-_____-________ No. in Family_____
Make__________________ Model__________________ No. Owned_________
E-mail address_______________________________________
I would like to receive my newsletter by ____ email or ____ regular mail.
Signature___________________________________________ Date__________ New______
Renew______
Please remit to: Trailblazers Off Road Club
PO Box 383
Independence, IA 50644
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ATV Association Of Iowa
www.atviowa.com
Please remit with payment.
I hereby apply for membership in the All Terrain Vehicle Association of
Iowa.
____Single/Family ($15) Donation to ensure the future of ATV's in Iowa
$_______________
___ Associate ($50)
Please Print
Name:______________________________________________________ Spouse:_________________________________________________
Number of children in household______________________________
Address: ______________________________ City:_________________ State:______
Zip:___________
County of Residence_________________________
Phone: _____________________________________________________
ATV club name: __________________________________________________________________
E-Mail:__________________________________________________
Your E-Mail address is very important, as this will be how we can get
information and newsletters to you much quicker.
Number of ATV's, Dirt Bike's and ORV's owned___________________________________________
Membership year runs thru Dec. 31st 2012. Included in membership is a
subscription to periodical newsletter and representation on ATV issues.
Send your membership form, dues and any donations today to:
ATVAI c/o Treasurer Michael Rygh
45563C Hwy 69 Lake Mills, IA 50450
mj_rygh45@hotmail.com
Thank you for your support!
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