First Name____________________________ Last Name___________________________________

Street Adress_______________________City_______________State_________Zip Code____________

Phone #___________________

Club membership = $25.00 which includes (1) NYSSA membership (1) club sticker
If you would like additional members of your household to be a NYSSA member it will be a additional $5.00
a person.

A family membership to the club is no additional charge.
Spouse First name______________ Children's name _______________________________________

Please check here ( ) if you would not like $0.25 of your NYSSA dues for the nys snowmobile political action committee who is our voice in Albany. Either way you dues remains the same.

We do all of our trail work on volunteer basis (Trail development, trail maintenance, trail grooming and
groomer maintenance). If you are unable to volunteer and would like to make a monitory donation to the
trail fund it would be greatly appreciated.

Membership----------------------------------------------------($25.00)

Additional NYSSA Member____________x$5.00 =_______

Additional club Stickers_______________x$3.00 =_______

Trail donation--------------------------------------------------_______

Total due--------------------------------------------------------_______

By signing below I am agreeing to adhere to the rules and regulations of N.Y.S snowmobile laws, Grafton
Trail Blazers inc, its insurance carriers, landowners and lease holders. It is agreed that the head of the
household is signing this agreement representing his/her entire family.

Sign_______________________________Date______________________________

Club Use
Voucher ID #________________________ Land Owner ( )

Membership form for the

Grafton Trail Blazers

PO Box 221 Grafton N.Y. 12082

Please print form and send back to the above address

Please check one

( ) Renewal

( ) New Membership

Please make checks payable to
Grafton Trail Blazers

E-Mail Address_______________________