MEMBERSHIP APPLICATION

WESTERNMASS ATV ASSOCIATION, INC.
PO BOX 557
Dalton, MA   01227

Name:   first             last   
Address:               
City/Town:  
State:                    Zip Code           
Telephone:            Email:
Type of ATV/Dirt Bike (year, make, model)

Waiver:
I, the undersigned, waive all rights from accident or injury while riding on trails with, or participating in any event involving, the WESTERNMASS ATV ASSOCIATION, INC.  I fully understand that the sport of ATV and dirt bike riding can be dangerous, and involves the risk of injury or death.          

If applying online, type the words  I agree  (case sensitive) in the following box to acknowledge and agree to the liability waiver:         

(Must be an ORV rider & at least years 18 old)

If applying by mail, type in information, print the page and sign below to acknowledge and agree to the liability waiver.

Signature: ________________________________    Date:  
(Must be an ORV rider & at least years 18 old)

Annual Membership Dues:  

  $20.00 Single  

$30.00 Family (Same Household) 

Supply up to 3 names (with ages of minors)

Print & mail form with a check or click "Submit" below.  A simplified print-only version of the form is available at this link: printable application