MEMBERSHIP FORM

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APPLICATION FOR MEMBERSHIP

*NAME:______________________________________________________________

*PHYSICAL ADDRESS:_________________________________________________

*MAILING ADDRESS:__________________________________________________

*CITY / STATE / ZIP:____________________________________________________

*PHONE:______________________________________________________________

FAX:_________________________________________________________________

E-MAIL:______________________________________________________________

 

TYPE OF VEHICLE

YEAR:________MAKE:_____________________MODEL:____________________

FAMILY:

NAME RELATIONSHIP BIRTH DATE

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

I pledge to support the goals and objectives of the MAMMOTH LAKES EASTERN SIERRA 4WD CLUB in the protection, respect, and enjoyment of our public and National Forest lands and towards the betterment of off-highway recreation.

* SIGNED:___________________________________DATE:____________________

PAID:____________________

* = required information