My name is:

Address:

City:

State:

Zip:

My e-mail address is:

Home Phone:

Business Phone:

Cell Phone:

Fax:

I have resided in:

County

for:

years.

I have been riding off-highway vehicles for:

years.

I am aware that the Martin County OHV Club has the opportunity to obtain usage of some land to create an OHV Recreational Facility. When this comes to fruition, I would definitely like to be a member of the club so I, along with my friends and family, can participate in one of our favorite activities in this local area.

Currently we travel approximately:

miles to ride.

We do this at least:

times/month

I would be willing to pay an annual membership fee of:

and a daily riding fee of:

If you need any assistance whatsoever with organizing the club or with any type of task please do not hesitate to contact me. I am skilled in the following areas:

-- Select One -- Administrative Work Construction Equipment Operator Equipment Maintenance EMT Facility Maintenance Flagger Food Service

Other:

My schedule would allow me to donate about:

hours per month

In addition, I also have access to the following equipment that I would be willing to donate or make available to the club at a reduced price:

Please supply numbers in Age Range of self and family riders:

10 or under

11 - 17

18 - 30

31 - 50

Over 50