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 $25.00
(  ) 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 ) who 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 (  )