Long Pond Sno Sled Club Inc. PO Box 543 Harrisville, NY   13648 www.longpond.freeservers.com   Membership year 09/01/2008-08/31/2009      First Name ______________________________________________________ Last Name ______________________________________________________ Street Address/PO Box _____________________________________ City _____________________________________________________ State _________________________ Zip Code _________________ Phone # ________________________________ Email ___________________________________ Number of sleds I intend to register _______ Membership Dues $25.00   Please make checks payable to Long Pond Sno Sled Club Have you already paid NYSSA Dues this season via another club? ________ If so, deduct $5 and enter name of club _____________________________   [   ] Twenty five cents of your $5 NYSSA dues will be used for the NYS Snowmobile PAC (Political Action Committee) who is our voice in Albany.  If you do not wish to contribute to the NYS Snowmobile PAC, please check this box.