Name: _____________________________________________________________________________

Address: ___________________________________________________________________________

___________________________________________________________________________

Phone Number: Home:________________________ Cell: _____________________________

Vehicle Make: _____________________ Model: __________________ ATV [ ] UTV [ ]

Individual/Family Member $20.00 [ ] $_____________

Business Member $40.00 [ ] $_____________

Donation: $_____________

Total Enclosed: $_____________

Please Check [ ] I understand that by joining the St. Germain ATV Club Inc. I will abide by all the rules and bylaws of the club. I also agree to follow all State of Wisconsin ATV laws and regulations, and that I will drive responsibly.

Signature: _________________________________________________________ Date: _______________________

Membership dates are from May 1st through April 30th of each year.

Please cut and paste this application form, print it, and mail it with your check for the proper amount to:

St. Germain ATV Club Inc.

PO Box 161

St. Germain WI 54558.