Cato Trail Blazers, Inc.
2011-2012 Application
Please print neatly. Thank you.
Last Name:__________________________ First Name:________________________________
**Your name must appear here exactly how it is your registration**
NYSSA ID Number:________________________ if available (as shown on your 2010-2011 membership card)
Name of Spouse:_______________________________________________________________
Address:______________________________________________________________________
City:____________________________ State:___________________ Zip Code:_____________
*Email:___________________________ Telephone:________________ Cell:______________
*Email is required to log on to the NYSSA website and also helps save the club money as our newsletters can be emailed.
How many snowmobiles are you registering? ______ (you do not need a snowmobile to join)
Additional Members: Under 18 years old and resides in same household and need to register your sled in same name
Name:________________________________ Relationship:___________________ Age:_____
Name:________________________________ Relationship:___________________ Age:_____
Name:________________________________ Relationship:___________________ Age:_____
Name:________________________________ Relationship:___________________ Age:_____
Membership Fee: $25.00 includes one NYSSA membership. If spouse chooses to also have a NYSSA membership, there is an additional $5.00 Fee.
Check box if you want an additional $5.00 NYSSA membership for spouse.
25 cents of your NYSSA dues will be used for the NYS Snowmobile Political Action Committee, who is our voice in Albany. If you don’t want 25 cents to be contributed to the PAC, then check this box. This will not change your membership fee.
Check this box if you already paid NYSSA dues via another club. Club Name:_______________________
Check this box if you would like to upgrade to a NYSSA Trail Defender Membership. Additional fee is $20.00. Visit NYSSA for information.
Check this box if you do not want to get mailings from NYSSA sponsors.
RELEASE/WAIVER
The undersigned agrees to the following in the event that I and/or others are injured while participating in rides or any activities of the Cato Trail Blazers, Inc. (Club):
I agree not to make any personal injury or property damage claims against the club
I agree to indemnify and hold harmless the Club for any personal injury claims or property claims made by any non-member who is my guest.
I agree not to make any personal injury or personal property damage claim against any municipal corporation or private property owner who grants permission to the Club to operate snowmobiles upon their property.
I agree to indemnify and hold harmless any municipal corporation or private property owner who grants permission to the Club and/or guests for any personal injury claims or property claims made by any non-member who is my guest.
Under penalty of perjury, I (we) hereby state the information given above is true to the best of my knowledge.
____________________________________________________________________________________________________________
All applicants Sign and Date
Please fill out and return this application along with your membership payment to the address above. Check or money order accepted. Cash only in person.
If you supply an email address, the Club newsletter will be emailed to you. This saves the Club money.