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Westbrook Trail Blazes
Membership Levels
 
$25.00 Individual Membership
Includes MSA Membership & $2000 MSA Life Insurance
 
$3.00 for each additional dependent
Includes $2000 MSA Life Insurance
 
$40.00 Business Membership
1 Individual Membership to Westbrook Trail Blazes, MSA and a link to your business website, from our site.
 
$15.00 Associate Membership
If you already belong to another club associated with MSA
 
 
 
 
 

MEMBERSHIP ON-LINE REGISTRATION
2009-2010

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
Spouses Name & DOB
Childs Name & DOB
Childs Name & DOB
Childs Name & DOB
  

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

INDIVIDUAL MEMBERSHIP - $25.00
One person membership ~ MSA AD&D Life Insurance

BUSINESS MEMBERSHIP - $40.00
Includes one individual membership & business link to web site.

ASSOCIATE MEMBERSHIP - $15.00
Only use this membership if you already belong to another club that is associated with MSA.

MAIL IN OPTION
(MAIL PAYMENT AND APPLICATION TO US)

Download Membership Application

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