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Get Membership Application - Eagle Lake Winter Riders

September 30, 2012 Eagle Lake Winter Riders P.O. Box 294, Eagle Lake, Maine 04739 email: membership eaglelakewinterriders.com web: www.eaglelakewinterriders.com MEMBERSHIP APPLICATION FORM Member Name: Mailing Address: City, State, Zip Telephone: E-mail: Date of Birth: Beneficiary For Insurance: Total Number of Members in Family: Additional insurance for spouse and dependents is available at a cost of $2.00 per dependent. Eligible Dependents are the named member s spouse and any unmarried.

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