Sacandaga Snowmobile Club

                                          P.O. Box 1120
                               Northville, New York 12134
First Name ( Print Only)_______________________________________
Last Name______________________________________________________________
Street Address/P.O.Box _____________________City________________________
State ___________________________ Zip code ______________________________
Family Membership Information
Spouse first name _______________Last Name _____________________________
Children under 18 that intend to register a Sled
________________________________________________________________________
Phone #'s ______________________________________________________________
E-mail ( Use correct case and Print Clearly )
_______________________________________________________________________
Check Membership Type:
(  ) Single membership $30.00
(  ) Family Membership $ 35.00


Have you already paid NYSSA dues this season via another Club? _____________
or are you currently engaged in full time active military service with the Army, Navy, Air Force, Marines, Coast Guard or been Awarded the Purple Heart?
If so, deduct $5.00 from the above dues and enter the name of the club or include a copy of your military ID __________________________________


Number of sleds I intend to register ________

(  ) Twenty five cents of your $5.00 dues will be used for the NYS Snowmobile PAC (Political Action Committee) which is our voice in Albany. If you do not wish to contribute to the NYS Snowmobile PAC, please Check the box. Please note, your NYSSA dues remain $5.00
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For Club Use Only:
Blank Voucher ID # Issued_____________________
Snowmobile  Trail Land Owner (  )
Military Honorary (  )