membership / renewal application

MEMBERSHIP / RENEWAL APPLICATION12 month membership in Quad Cities ATV Club (Annual renewal);

Quad Cities ATV newsletter (one issue per year);Membership to ATVAM, the All-Terrain Vehicle Association of Minnesota;

Subscription to Minnesota Off -Road Magazine (six issues per year).

Quad Cities ATV Club • P.O. Box 83 • Virginia, MN 55792 • quadcitiesatv.com • quadcitiesatvclub@gmail.com

Annual Membership Fees: Current ATVAM Member through another ATV ClubIndividual ...................................................$25.00 Individual ...................................................$5.00 Family .........................................................$30.00 Family .......................................................$10.00Business: Business .................................................. $30.00 Silver ..............................................$100.00 Current ATVAM Member ID ______________________ Gold .................................................$150.00 I would like to donate Platinum ....................................... $200.00 an additional $_________________________________

Contact Information:Name(s) __________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Children with ATV Safety Certifi cates _________________________________________________________________________________________________________________________________________________________ Children you wish to become ATV Certifi ed __________________________________________________________________________________________________________________________________________ Address: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________ City: ______________________________________________________________________________________________________State: _________________________________________________Zip: __________________________________________________________ Phone (home): ____________________________________________________________________________ (cell): _____________________________________________________________________________________________________________________ Email: (please write neatly) _________________________________________________________________________________________________________________________________________________________________________________ Signature: _____________________________________________________________________________________________________ Date: ___________/__________/________________

Check Payable to Quad Cities ATV Club Check #: _______________________________________________________________________________________________________________

For more information contact one of our club offi cers: Dave Dincau • 218-780-4522 • dcibuild2002@yahoo.comRyan Horan • 218-290-3315 • ryanhoran81@gmail.com • Al Larsen • 218-780-5543 • allen.larsen@state.mn.usJon Ahola • 218-248-0925 • aholaconstruction@gmail.com • Lisa Suihkonen • 218-290-3700 • soik2@live.com

Dan Lauritsen • 218-780-1732 • cindylauritsen1957@gmail.com • Cindy Lauritsen • 218-744-1528 • cindylauritsen1957@gmail.comShannon Bergman • 218-966-9838 • sebergman71@gmail.com • Jeff Leese • 218-750-7652 • jeffl @wafi shermn.com

John Vukmanich • 218-410-3308 • johnvukmanich@gmail.com • Ed Cvek • 218-780-0084 • edwcvek@gmail.com