NOTE:  Memberships run from July 1 to June 30

For annual memberships please print and mail this form to:

Millsfield ATV Club
C/O Pauline Bergeron
36 Countryside Ave.
Berlin NH 03570

Make checks payable to the Millsfield ATV Club


Name ___________________________________        Date ____________


Address __________________________________       City_____________________ 

State ____  Zip __________  

                   
Email Address______________________________      Phone _____________________

Please check here if new Member  ______ Please check here if new address  _______   

Specify names if you would like to have a membership card for each family member:

___________________________________________________________________________________

Membership type:

___  Single   $15
___  Family   $25

___  Single with map $20
___  Familiy with map $30

___  Non-member map request $10
___  Existing member map request $6