Name:________________________________________

Address:______________________________________

City:_____________ State:____ Zip Code:___________

Phone: (       ) __________________________________

Dues are  $10 per year (payable every January)

$25 Membership will recieve Mudrats T-shirt.

 BY JOINING THIS CLUB YOU AGREE TO KEEP TRAILS LITTER FREE, AND CAUSE TO DAMAGE TO ANY TRAILS RIDDEN.  WE ALSO HEREBY RELEASE HARLAN COUNTY FISCAL COURT AND ITS MEMBERS, ANY AND ALL LANDOWNERS, ANY AND ALL CLUB MEMBERS, ANY ALL PARTIES THAT MAY BENEFIT FROM ATV RIDES, FROM ANY INJURY TO MYSELF OR ANYONE IN MY PARTY FROM ANY DAMAGE TO MY ATV OR ANY VEHICLES USED ON RIDE.

Signature:________________________________                   Date:____________________________

Mail to:

Erik Cain

P.O. Box 1001

Loyall, KY 40854