Westbrook Trail Blazes

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Westbrook Trail Blazes
Membership Levels
 
$25.00 Individual Membership
Includes MSA Membership & $2500 MSA Life Insurance
 
$30.00 Family Membership
Includes MSA Membership & $2500 MSA Life Insurance on each dependent. 
 
$40.00 Business Membership
Includes MSA Membership for1 Individual and a link to your business website, from our site.
 
$10.00 Associate Membership
(If already a member of another MSA Club).
 
 

MAIL IN OPTION
(MAIL PAYMENT AND APPLICATION TO US)

Download and Print Application Here

Mail this form and payment to:
 
Westbrook Trail Blazes
Attn:  Jeff Todd/Treasurer
PO Box 1244
Westbrook, Maine  04098

 
 
 
MEMBERSHIP ON-LINE REGISTRATION
2011-2012

ONCE YOU HAVE COMPLETED YOUR ONLINE REGISTRATION FORM, PLEASE RETURN TO THIS PAGE AND SELECT ONE OF THE PAY NOW OPTIONS BELOW.

Do not list your dependent information if you are joining as a "Individual" member

Name (First & Last)
Address (Street)
Address(City,State,Zip)
Date of Birth (mm/dd/yyyy)
Telephone #
E-Mail Address
Beneficiary for MSA AD&D Insurance
Dependent Spouse, DOB & Beneficiary
Dependent Child, DOB & Beneficiary
Dependent Child, DOB & Beneficiary
Dependent Child, DOB & Beneficiary
  

INDIVIDUAL MEMBERSHIP - $25.00

FAMILY MEMBERSHIP - $30.00

BUSINESS MEMBERSHIP - $40.00

ASSOCIATE MEMBERSHIP - $10.00