Southern Maine Sno-Goers Membership Application
Date: ____________ ( ) New ( ) Renewal
Name: __________________________________________
Date of Birth: ___________________
Address:_____________________________________________________________
City: __________________________________ State: ____________
Zip Code: ____________
Phone Number: _______________________
Beneficiary: ________________________________
E-mail Address: _____________________________________
Optional Dependents Insurance: (NO COST for Spouse and/or 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 |
| $27 - Membership |