Membership Renewal Application

Membership Renewal Application

Membership year is from April 1st through March 31st
What you will need to complete your membership application.
- Printed color copy of waiver. You'll need to sign and attach the waiver to the application.
  - Adult Waiver : Member and spouce can sign the same waiver.
  - Minor Waiver : One waiver per child.
- Upload a copy of Insurance(s) for all machines.
- Upload a copy of ATV/SxS regstration.
New or Renewal *

New Renewal
Application Type *

Paper Online
How would you like to receive your tag(s)?: *

Mail Pickup at the club
Member's information
Name: *

First Name Middle Name Last Name Suffix
Birthdate: *

Month Day Year
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Type *

Home Mobile
Phone Number *
Email *
Email about work parties *

Yes No
Participate on a Committee? *

Yes No
Family Membership Information

Family members are a spouse and any children under the age of 18.
Are you adding family members to your membership? *

Yes No
How many Family Members are you adding to your membership? *
Family Member 1: *

First Name Middle Name Last Name Suffix
Birth Date1: *

Month Day Year
Family Member 2: *

First Name Middle Name Last Name Suffix
Birth Date2: *

Month Day Year
Family Member 3: *

First Name Middle Name Last Name Suffix
Birth Date3: *

Month Day Year
Family Member 4: *

First Name Middle Name Last Name Suffix
Birth Date4: *

Month Day Year
Upload waivers: *

Browse Files
A minor waiver is required for each minor. One adult waiver can be singed by each adult. Cancel of
Insurance Information

Copy of Insurance card is required.
Insurance Co. Name1: *
Policy Number1: *
Exp. Date1: *

Month Day Year
Date
Adding a 2nd policy: *

Yes No
Insurance Co. Name2: *
Policy Number2: *
Exp. Date2: *

Month Day Year
Date
Upload Copy(s) of Insurance: *

Browse Files

Cancel of
ATV/SxS/Dirtbike

ATV/SxS registration is required. Dirtbike registration is not required.
How many machines are on your membership? *
Machine type1: *

ATV SxS Dirtbike Dual Sport
Year1: *
Make1: *
Model1: *
State1: *
Plate Number1: *
Insurance1: *
Refers to the insurance above.
Machine type2: *

ATV SxS Dirtbike Dual Sport
Make2: *
Year2: *
Model2: *
State2: *
Plate Number2: *
Insurance2: *
Refers to the insurance above.
Machine type3: *

ATV SxS Dirtbike Dual Sport
Make3: *
Year3: *
Model3: *
State3: *
Plate Number3: *
Insurance3: *
Refers to the insurance above.
Machine type4: *

ATV SxS Dirtbike Dual Sport
Make4: *
Year4: *
Model4: *
State4: *
Plate Number4: *
Insurance4: *
Refers to the insurance above.
Machine type5: *

ATV SxS Dirtbike Dual Sport
Make5: *
Year5: *
Model5: *
State5: *
Plate Number5: *
Insurance5: *
Refers to the insurance above.
Registration for Machine(s)

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Dirt bikes are not required to have registration. Cancel of
Cost of Membership
Payment Type *

Paypal Cash Check Dealer Paid
Check #

Number of Tags

First Tag $ 95.00

Annual membership fee for Individual and Family membership with one machine.

2nd Tag $ 25.00

This additional fee upgrades individual membership to a two-machine family membership with a second Indian Creek Valley ATV Club tag.

3 or more tags $ 10.00

Order additional tags after the second machine.

Quantity

Enter coupon

Total $ 0.00

Applicant Signature *

Clear
Paper application

Browse Files
Offical use for captureing signture on Papper application. Cancel of
Should be Empty:

Membership Renewal Application

Member's information

Family Membership Information

Insurance Information

ATV/SxS/Dirtbike

Cost of Membership