OSSA Membership Application Print out and send in with payment.

OSSA Year: July 1st to June 30th

Annual Membership Dues

(_) New $25 ------- (_) Renew $25 ------- (_) Business $25

Last Name:______________________________________________

First Name:______________________________________________

Spouse:_________________________________________________

Address:________________________________________________

City:____________________________________________________

State/Zip:________________________________________________

Home Phone:__________________Work Phone:_________________

Club Name:______________________________________________

No. of Family Members___________No. of Machines_____________

State Association Dues .........................................$________

Club Dues ............................................................$________

Total Enclosed for OSSA .....................................$________

Donation to Legal Action Fund .............................$________

Local Club Name:__________________________________________

Contact:______________________________Phone:______________

Mail to: Oregon State Snowmobile Association P.O. Box 435, LaPine, OR 97739 1-888-567-SNOW (7669)