Southern Maine Sno-Goers Membership Application
Date: ____________ ( ) New ( ) Renewal ( ) Family ( ) Single
Name: __________________________________________
Date of Birth: ___________________
Address:_____________________________________________________________
City: __________________________________ State: ____________
Zip Code: ____________
Phone Number: _______________________
Beneficiary: ________________________________
E-mail Address: _____________________________________
Optional Dependents Insurance: ($2.00 ea. for Spouse and Children under 19)
Name Date of Birth Beneficiary
____________________________ ______________ _________________________
____________________________ ______________ _________________________
____________________________ ______________ _________________________
____________________________ ______________ _________________________
____________________________ ______________ _________________________
(Please detach at dashed line and mail with check to SMSSC, PO Box 1083, Sanford, ME 04073)
| Membership Application |
| $25/Family |
| $20/Single |