Name: _____________________________________________________________________________

Address: ___________________________________________________________________________

City: ___________________________________________________________________________

State: _________________________________Zip Code___________________________________

Email Address: ________________________________________________________________________

Phone Number: Home:________________________ Cell: ______________________________________

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

Individual/Family Member $20.00 [ ] $_____________

Business Member $40.00 [ ] $_____________

Map Ad (Includes Business Membership) $150.00 $_____________

(Please include a camera ready or printable proof of your ad)

Double Map Ad $ 200.00 $_____________

Donation: $_____________

Total Enclosed: $_____________

Please use my map ad that was on the map last season. Please Check [ ]

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.