LIORV Membership Application

 

SINGLE           FAMILY          RIDING AREA

 

Primary member name________________________________ Age___ Sex____

Address___________________________________

City_________________ State_____ Zip_________

Home Phone______________________

Cell Phone ______________________

Email Address _____________________________

In case of emergency call______________________________

Name(s) of family riders_______________________________

__________________________________________________

__________________________________________________

Your Occupation____________________________________

 

Please Check all that you own:

ATV___        Off-Road Motorcycle___     Snowmobile___

Street Motorcycle___                   Personal Watercraft___

 

I, the undersigned, do hereby acknowledge receipt of a copy of, and agree to abide by all

LIORV rules and regulations. I also acknowledge the risk of injury to my person or

property and to others while riding, patrolling, practicing or competing at all LIORV

Events. I know and understand that off road riding is a dangerous sport and I will rely on

my own Judgment and ability and assume all risk of injury or damage while riding. I

will not file suit against LIORV, its officers, it members or any land owner whose

property I ride. Permission to ride on any land is given directly from the land owner.

I understand this membership is valid for the current calendar year only

and the membership dues are not pro-rated. I give LIORV the right to share my address

information with dealers and other Industry businesses for their mailing lists.

 

Please select membership you are applying for:

 

_____ Silver Membership (Immediate Family* )

$25.00 Donation Annually

 

*Immediate Family - Husband, Wife, Children

 

x_____________________________________      ___________________

Signature                                                                     Date

 

x_____________________________________      ___________________

Signature of Parent or Guardian if under 18               Date

 

Make Checks Payable to: Long Island Off Road Vehicle Association

Send Checks to: LIORV Membership Dept

                             PO BOX 1252

                             MILLER PLACE NY 11764

Memberships

 

There is one type of membership available as of March 2006: Silver Membership

Membership
Silver Membership (Supporter's Discount Card) (Immediate Family*)	$25.00 Suggested Donation Annually

 

*Immediate Family - Husband, Wife, Children

 

Revised: Jan 29, 2006