Deerfield Snow Trails Inc.

P.O. Box J

Marcy, NY 13404

315-7330082 (application issues)

Membership Application

(Renewals: only need to record changes)

(Please Print)

Name :___________________________   Spouse / Children's Names (optional)        ___________________________

Physical Address :________________________________________________         ___________________________  

P.O. Box : _______________________________________________________       ___________________________

City : ______________________State : ______________  Zip : ____________       ___________________________

County :________________________________________________                         ___________________________

 E-Mail Address : _________________________________@__________________                                                           

Phone Number : _________________________                                                                                                                   

____ Check here if you DONíT want your phone & email shared with NYSSA   

  Membership Dues : $30.00 (includes $ 5.00 NYSSA dues and $1.00 SLEDNY dues) (NYSAA Mandated Charge)                      

           $ 24.00 (if you paid NYSSA dues thru another club. You will not receive a voucher)          

           Name of club you paid NYSSA dues to :_________________________________         

______  Check Here if you wish 25Ę of your $ 5.00 NYSSA dues to go to its political action committee                   

______  Check Here if you included an additional $ 20.00 to support the "trail defender" fund.                               

______ Check Here if you wish to received 3rd party ads through NYSSA                                                                    

Applicant Signature : _____________________________________    Date : __________________                                     

DeerfieldsSnowTrails.com

https://www.facebook.com/DeerfieldSnowTrails