2020 Check Membership Application Form

TMC Membership Check Payment Renewal Year 2022

To renew your membership please complete all questions. Phone Numbers are Optional
Adult 1 *

First Name Last Name
Adult 2

First Name Last Name
Child 1

First Name Last Name
Child 2

First Name Last Name
Birth Date Child 1

Month Day Year
Birth Date Child 2

Month Day Year
Child 3

First Name Last Name
Child 4

First Name Last Name
Birth Date Child 3

Month Day Year
Birth Date Child 4

Month Day Year
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail Adult 1
E-mail Adult 2
Home Number
Cellular Adult 1
Cellular Adult 2
Waiver *
Signature Adult 1 *

Clear
Signature Adult 2

Clear
Membership Type *

Resident individual annual dues $50 Non-resident individual annual dues+ $40 Resident family annual dues++ $75 Non-resident family annual dues* $50 Individual Unlimited Day Fees $50 Family Unlimited Day Fees $100 Donation to Conservation Donation to Club
Please remember the Unlimited Day Fee is in addition to the Dues Level. Choose Dues level first.

+A non-resident is defined as those who reside at least 150 miles from the Thendara gate at Harriman, NY.

++ A family is defined as two adults--married or not--and children under 23 living under one roof

Enter Total Fee Below. If Donating to Conservation or the Club Please specify the amount below.

Click Renew Membership.

Please make the check out to Thendara Mountain Club and mail your check to:

Thendara Mountain Club
c/o Vivienne Rollins

163 North Little Tor Road

New City, NY 10956-9998
Name of Member with Unlimited Day Fee
Can you volunteer to help the club?
Where can you help
Club Donation Amount
Conservation Amount
Mailed Check Payment Amount *
I will mail my check
Should be Empty:

TMC Membership Check Payment Renewal Year 2022