Ellis River Riders, Inc.

First Name *

First Name

Last Name *

Last name

Address *

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

Email Address *

Email address of PRIMARY MEMBER

Phone Number

( ) -

Primary Member's Age

List age IF under 18 (as of January 1st)

Membership Level *

Family Memberships cover all family members 21 years and younger living under the same roof

Membership Type *

Primary Member (For single memberships or family memberships where this member is paying the dues)
Associate Member (For family memberships where another family member is responsible for paying the dues)

Select which type of membership - select "Primary" for the member paying the dues - select "Associate" for family memberships where a primary member already paid dues

Family Members (for Family Memberships only)

List all family members and their age (if under 18)

Comments

Preferred Method of Communication *

Please select with method you prefer to receive notices, newsletters, etc. from the Secretary. Email (and Facebook) is the easiest, cheapest and most efficient method for the Club.

Ellis River Riders Membership (2018)