Membership Application

 Individual Membership is $25.00 ($20.00 to club/ $5.00 to NYSSA)

Name: ________________________________________________

Street Address: _________________________________________

City______________________Zip Code: ____________________

Phone: ___________________________

 Number of sleds to be registered_______

 E-Mail Address: ______________________________________

 Additional Household Members over 16 may join for $5.00 (which goes to NYSSA)

•  Additional Household Members:       1.________________________

                                                                           2. ________________________

                                                                           3. ________________________

                                                                           4. ________________________

 Club Address: Bath Sno- Flakes Snowmobile Club

                         6993 Cty Rte 15

                          Bath, New York 14810