Midwest Trail Riders Association Membership Application

Membership:
[ ] New [ ] Renewal
Old MTRA Number:
Type:

[ ] Individual $10.00 [ ] Family $15.00
[ ] Dealer $20.00 [ ] Club $20.00
[ ] Business $20.00

First Name:

Last Name:
First Names of Family Members:
(Dependents)

Home Address :
Number/Street

City
State
Zip
Home Phone:
Type of Rider:
[ ] ATV [ ] Motorcycle [ ] Both
AMA Member:

[ ] Yes,  Number:
[ ] No

Occupation:
Age:
Are you in anyway Disabled

[ ] Yes [ ] No

If yes, Please explain:
Are you interested in helping with the:

[ ] Potosi District
[ ] Salem District

Would you like to make a donation to the MTRA Land Purchase Fund?
Any other services you can provide?
I/WE THE UNDERSIGNED, HEREBY MAKE APPLICATION FOR MEMBERSHIP/RENEWAL OF MY/OUR MEMBERSHIP IN THE MIDWEST TRAIL RIDERS ASSOCIATION, (MTRA). I/WE AGREE TO ABIDE BY ALL RULES AND REGULATIONS AS STATED IN THE ASSOCIATION'S ARTICLES OF INCORPORATION AND BY-LAWS. I/WE SHALL AND HEREBY DO, FOR MYSELF, MY HEIRS, EXECUTORS, ADMINISTRATORS, AND ASSIGNS, RELEASE, DISCHARGE, AND FOREVER HOLD HARMLESS, THE MTRA OFFICERS, PAST AND PRESENT, THE AMA, U.S. FOREST SERVICE, FROM ANY AND ALL CLAIMS OR LIABILITIES DIRECTLY AND INDIRECTLY AS A RESULT OF ALL INJURIES (INCLUDING DEATH) AND/OR ACCIDENTS TO OR CAUSED BY MYSELF WHILE ENGAGED IN ANY FORM OF MOTORCYCLING (INCLUDING ALL TYPES OF ATVS) RIDING ANY MOTOR VEHICLE, OR ANY OTHER ACTIVITIES PERFORMED BY MYSELF IN CONNECTION WITH THE MIDWEST TRAIL RIDERS ASSOCIATION INC., AND FREE SAID ORGANIZATION FROM ANY RESPONSIBILITY THEREWITH. I/WE ALSO AGREE TO HOLD BLAMELESS THE OWNERS OF ANY PROPERTIES THAT I/WE MAY CROSS DURING ANY MTRA ACTIVITY FOR ANY LOSSES OR INJURY (INCLUDING DEATH). I ALSO CERTIFY THAT I AM 18 YEARS OF AGE OR OLDER. IF UNDER 18, I MUST HAVE PARENTAL CONSENT.
Signature is required for all applicants
_____________________________
Signature of Applicant / Date
_________________________________
Signature of Family Member/  Date
_____________________________
Signature of Family Member/  Date
_________________________________
Signature of Family Member/  Date
_________________________________
Signature of Parent/Guardian
(If Required)/  Date

Make check payable to and return to:

MTRA
P.O. Box 1203
Maryland Heights, MO 63043

Membership Dues are not tax deductible

[1]
[2]

[3]
[4]
$
_________________________________
Signature of Family Member/  Date
Please print this application, complete it and mail to address below.
[ ] "Adopt-A-Trail [ ] Constr. Projects
[ ] "Strike Force" (Letter Writers)