ALASKA MOTOR MUSHER'S CLUB

MEMBERSHIP APPLICATION

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PLEASE PRINT CLEARLY

NAME:_______________________________________AGE:___________

MAILING ADDRESS:________________________________________

___________________________________________________________

CONTACT#'S home______________work____________email___________________

RACER # REQUEST: 1st choice_________2nd choice_______________

MEMBERSHIP FEES:

_________non-competitive $30.00

_________family (immediate) $100.00

_________single $50.00

**ALASKA MOTOR MUSHER'S CLUB RESERVES THE RIGHT TO REFUSE MEMBERSHIP TO ANYONE.**

SIGNATURE: ________________________DATE:________________

PRIMARY MEMBER

SIGNATURE:________________________ DATE:________________

PARENT/GUARDIAN IF UNDER 19

PLEASE RETURN TO: AMMC

PO 45

Willow, AK 99688

FAX: (907) 495-5010

AMT PAID $____________RECEIVED BY___________________DATE:__________