Montachusett Ski Club Membership Application 2009/2010
Last Name
First Name
Street Address
City / Town
State Zip
Code Age
Phone Number
- -
EMAIL Address
@
Additional Family Members
Name Age
Name Age
Name Age
Name Age
Name Age
Name Age
Membership Type
$50
Membership per household adult (includes children 18 and under)
Payment (____ adults x $50 = $______)
$35 Senior
Membership (65 and over)
Payment (____ seniors x $35 = $______)
Check all that applies
Yes,
the Avalanche may publish my name and/or photo and/or phone number when needed.
Please
provide a hardcopy of the Avalanche Newsletter to my mailing address.
The ski
club may share my EMAIL address with other club members as needed.
Please mail the
application along with appropriate payment to:
Fran Spano