DVSJ TMA Renewal

2011/2012

Resident ( ) Non-Resident Property Owner ( ) Non-Resident ( )

Name of Registered Owner

First Middle Initial Last

Mail Address

Number & Street City State Zip Code ______

Legal Address (if different)

Number & Street City State Zip Code ______

Telephone Number(s) E-Mail Address ______

Snowmobile Information

Year Manufacturer Model Serial # Registration # State

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________

TMA Fees

# of Regular Snowmobiles @ _____ each = __________

# of Family Snowmobiles @ ______each = __________

# of Classic Snowmobiles @______each = __________

Club Dues

Total Snowmobiles @ $20 each = ___________

Optional

Donation to help defray the cost of storm damage repairs: _________.

Total Enclosed________________________

LIMITED LIABILITY STATEMENT/Personal Liability Insurance

As a member of a snowmobile club I, the undersigned, owner of the snowmobile(s) described above, am liable for the use of a trail in conformance with the

snowmobile laws and rules of the state of Vermont. Without limiting the generality of the foregoing, I declare that I am well aware of the risks related to the

presence of tree branches, stones and soil on the trail as well as the risks related to the maintenance and signing of a trail. I also pledge that I will inform any

person to whom I would lend or rent the snowmobile that I own, of the risks mentioned above and will advise them that the association, the club or the owner of

the trail do not assume any responsibility for the damages they could undergo while using a trail.

As of September 1, 2003, every individual operating a snowmobile in Vermont is required to have personal liability insurance. The minimum

required coverage is $25,000 for one injury or $50,000 for two or more injuries or deaths with a minimum of $10,000 property damage. The fine for

operating without the insurance is $601.00 plus court cost.

All snowmobilers born after July 1, 1983 must have (and carry with them) a Vermont Snowmobile Safety Certificate or equivalent

_______________________ ____________________________________________________________________

Date Signed Signature

Forward TMA(s) in US Mail________________ Hold TMA(s) for Pick Up______________________