Knott County Trail Riders

ATV Club

MEMBERSHIP FORM

Name: ______________________________________ Spouse: _____________________

Address: _______________________________________________

City: ____________________________ State: ___________ Zip: ___________________

Phone: (_____)________-________________

Cell Phone: (_____)________-________________

E-Mail: _________________________________________________

Additional Names of Family Members:

____________________ ____________________ ____________________

____________________ ____________________ ____________________

____________________ ____________________ ____________________

Family members listed on a family membership plan must live in the household.

I agree to obey all Knott County Trail Riders ATV Club Rules and everyone rides at his or her own risk under KRS 411.190 following the rules and regulations established in KRS 189.515. I acknowledge that the Knott County Fiscal Court, Knott County Trail Riders ATV Club, Knott County ATV Training Center is neither liable, nor responsible for Accidents, Damage, Loss, or Theft of personal property or Personal Injury to any Members or Visitors during the events! I acknowledge that I have read the rules and I accept any and all risks associated with any events or trails while in Knott County.

SIGNATURE: ____________________________ Date: __________

(Please sign here letting us know that you and the above names have read the rules and regulations and agree to abide by them.)

New: _____ Renewal: _____ Update Information: _____ E-Mail Only: _____

Send form and check/money order to:

Knott County Trail Riders ATV Club

Po Box 217

Hindman, Ky 41822

Phone #: (606)653-3911

Fees

$25.00 per person or $40.00 per family

Firefighter, EMS, Law Enforcement, & Military with ID get $10.00 off

Knott County Trail Riders Inc.

Revised December 2009