Oppenheim Trailblazers Membership Application
Sept 1, 2009 to August 31, 2010
1 yr family membership $35.00
Price includes $5.00 NYSSA dues. If you pay NYSSA dues through another Club,please list Club’s name and deduct $5 __________________________________
Check one: ___Renewal ____New Membership
Do you need a NYSSA Voucher?
Check One: ___ Yes or ___NO
Please Print Legibly and fill out completely
Name_____________________________________ Date__________
Address: (must match registration)
Street or PO Box____________________________
City ____________________ State _____ Zip ________
Home Phone:_____________ Email___________________________
Number of sleds I intend to register:____
Spouse Name______________________________
Children under 18 years of age are included with above Membership
Child Name ______________________ Age ____
Child Name ______________________ Age ____
Child Name ______________________ Age ____
(use back of form if necessary)
Make checks payable to Oppenheim Trailblazers
PO Box 172, Dolgeville,NY 13329
Payment method: Check $______ Cash $______
