First Name:

Last Name:

Address:

City:

State:

Zip:

Country:

Phone Number:

### ### ####

Email:

Membership Type:

Club Membership and OSSA Dues - $50.00 USD Club Membership Only Dues - $15.0 USD Business Membership - $50.00 USD

If OSSA Dues were paid through another club, please write the club name below:

Number of Family Member(s):

1 - Family Member 2 - Family Members 3 - Family Members 4 - Family Members 5 - Family Members 6 - Family Members 7 - Family Members 8 - Family Members 9 - Family Members 9+ - Family Members

Number of Snowmobile(s):

1 - Snowmobile 2 - Snowmobiles 3 - Snowmobiles 4 - Snowmobiles 5 - Snowmobiles 6 - Snowmobiles 7 - Snowmobiles 8 - Snowmobiles 9 - Snowmobiles 9+ - Snowmobiles