Cold Smoke Riders Online Membership Form

Name *

Mailing Address *

City *

State/Province *

ZIP / Postal Code *

Email Address *

Phone *

Date of birth *

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Select membership type *Individual $30Business $40

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Business Name

Business Owners Name

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Cold Smoke Riders Mail in Membership Form

Please print and fill out form, then mail with a check to the address on form.

Name:___________________________________

Mailing Address:
_________________________________________

_________________________________________

Email Address:____________________________

Date of birth:___/___/___ Phone #____________

Membership type:

Individual $30.00 -  ⬜						
     
# of people in family	 __________

Business    $40.00 -  ⬜			

Please make check payable to Cold Smoke Riders

Mailing address:
Cold Smoke riders ℅ Sonya Broussard
143 Sargent Hill DR, Milo, ME 04463