Return to: MNSC
Attn: Ms. Susan O'Brien
277 Monroe Road
Hampden, Maine 04444
*************************************************
Name: ___________________________________ Date of Birth:__________________
Mailing Address: __________________________________________________________
Town: ___________________________________ State:__________ Zip:___________
Phone:___________________________________ Email:__________________________
Additional Family Members
Name:____________________________________ Date of Birth:__________________
Name:____________________________________ Date of Birth:__________________
Name:____________________________________ Date of Birth:__________________
Name:____________________________________ Date of Birth:__________________
Dues
Regular Individual Member.............................................$10.00
Two Family Members....................................................$15.00
Family Membership.....................................................$25.00
Please Make Checks Payable to Maine Nordic Ski Club
Would you like to be on the MNSC e mail discussion list? ____Y____N
I waive and release the Maine Nordic Ski Club, their sponsors, and representatives
from all claims or liabilities of any kind arising out of participation of club
activities. I understand that the membership list may be exchanged with other
members or related organizations.
Signature:______________________________________ Date:_______________________
Additional Family Members Signatures (Parent/Guardian if under 18 years old)
Signature:______________________________________ Date:_______________________
Note: During the year, please forward any membership information changes such as
Email addresses to: spob@midmaine.com